Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn's disease.
Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn's disease.
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DOI：
10.1371/journal.pone.0180036
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Andoh A
中科院分区：
文献类型：
--
作者：
Bamba S;Sasaki M;Takaoka A;Takahashi K;Imaeda H;Nishida A;Inatomi O;Sugimoto M;Andoh A
骨骼肌体积与炎症性肠病(IBD)患者预后的关系仍未确定。我们对72例因病情加重而入院的IBD患者进行了回顾性研究。我们招募了接受腹部计算机断层扫描的IBD患者，并评估了营养指标，如Onodera的预后营养指数(O-PNI)和控制营养状态(CONUT)指数。L3骨骼肌指数(SMI)，即第三腰椎水平骨骼肌横截面积与高度平方的比率，用于识别骨骼肌减少症。42%的IBD患者(37%的克罗恩病(CD)和48%的溃疡性结肠炎(UC))出现骨量减少，定义为低SMI。UC患者的O-PNI、Conut值、身高和白蛋白水平显著低于CD患者。IBD患者的SMI与性别、体重、白蛋白水平和O-PNI密切相关。COX回归模型多因素分析显示，石蜡包埋(P=0.015)和疾病类型(CD或UC)(P=0.007)是预测手术切除的重要因素。采用Kaplan-Meier方法和LOG-RANK检验对CD患者进行分层分析，发现发生肉瘤的患者的累积无手术生存率显著低于所有IBD患者(P=0.003)和CD患者(P=0.001)。L3骨骼肌面积是CD患者进行肠切除的预后因素。
The relationship between skeletal muscle volume and the prognosis of patients with inflammatory bowel disease (IBD) remains undetermined. We conducted a retrospective study of 72 IBD patients who were admitted to the hospital due to disease exacerbation. We enrolled IBD patients who had undergone abdominal computed tomography and assessed the nutritional indices, such as the Onodera’s prognostic nutritional index (O-PNI) and the controlling nutritional status (CONUT) index. The L3 skeletal muscle index (SMI), which is the ratio of the cross-sectional area of skeletal muscles at the level of the third lumbar (L3) vertebra to the height squared, was used to identify sarcopenia. Sarcopenia, defined as a low SMI, was observed in 42% of all IBD patients (37% with Crohn’s disease (CD) and 48% with ulcerative colitis (UC)). In UC patients, the O-PNI and CONUT values, height, and albumin levels were significantly lower than in CD patients. The SMI strongly correlated with sex, body weight, albumin level, and O-PNI in IBD patients. Multivariate analysis using the Cox regression model demonstrated that the presence of sarcopenia (P = 0.015) and disease type (CD or UC) (P = 0.007) were significant factors predicting intestinal resection. The cumulative operation-free survival rate was significantly lower for sarcopenic patients than in all IBD patients (P = 0.003) and a stratified analysis of CD patients (P = 0.001) using the Kaplan–Meier method and log-rank test. The L3 skeletal muscle area is a prognostic factor for intestinal resection in patients with CD.