The impact of increased body mass index on the clinical course of Crohn's disease
The impact of increased body mass index on the clinical course of Crohn's disease
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DOI：
10.1016/j.cgh.2005.12.015
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发表时间：
2006-04-01
影响因子：
12.6
通讯作者：
Lichtenstein, GR
中科院分区：
文献类型：
--
作者：
Hass, DJ;Brensinger, CM;Lichtenstein, GR
背景与目的：脂肪组织中肿瘤坏死因子- α的产生已被充分证实。克罗恩病（CD）患者脂肪组织增加可能有更严重的疾病。这项研究评估了超重的乳糜泻患者，以确定他们的临床过程是否与正常或低体重指数（BMI）的患者不同。方法：选取1997 ~ 2002年在宾夕法尼亚大学附属医院就诊的患者为研究对象。数据收集自门诊记录和标准化访谈。超重定义为BMI为25 kg/m(2)或更高。主要结果是第一次手术的时间。次要结局包括诊断年龄、手术次数和治疗升级。将诊断时BMI为25 kg/m(2)或更高的患者与BMI小于25 kg/m(2)的患者进行统计分析。生存分析与第一次手术时间比较。结果：共纳入148例患者。48例（32.4%）在诊断时BMI为25kg /m(2)或更高。BMI为25 kg/m(2)或更高的患者在诊断时年龄较大；BMI小于25 kg/m的患者35年vs 22.5年(2)（P = 0.0001）。手术次数、治疗升级和疾病分布在两组之间没有差异。BMI小于18.5 kg/m(2)的患者与BMI大于等于25 kg/m(2)的患者的首次手术时间分别为252个月和24个月，差异有统计学意义（P = 0.043）。结论：诊断时BMI为25 kg/m(2)或更高的CD患者比BMI小于18.5 kg/m(2)的患者在诊断时年龄更大，首次手术时间更短。这表明超重的乳糜泻患者需要更早的手术干预和更积极的药物治疗。
Background&Aims: Tumor necrosis factor-alpha production in adipose tissue is well documented. Crohn's disease (CD) patients with increased adipose tissue may have more severe disease. This study evaluated overweight patients with CD to determine if their clinical course differs from those with a normal or low body mass index (BMI). Methods: Patients at the Hospital of the University of Pennsylvania from 1997 to 2002 were included. Data were collected from outpatient records and standardized interviews. Overweight was defined as a. BMI of 25 kg/m(2) or higher. The primary outcome was time to first surgery. Secondary outcomes included age at diagnosis, number of surgeries, and escalation of therapy. Patients with a BMI of 25 kg/m(2) or higher at diagnosis were compared with patients with a BMI of less than 25 kg/m(2) using statistical analyses. Survival analysis compared time to first surgery. Results: A total of 148 patients were included. Forty-eight (32.4%) had a BMI of 25 kg/m(2) or higher at diagnosis. Patients with a BMI of 25 kg/m(2) or higher were older at diagnosis; 35 years vs 22.5 years for patients with a BMI of less than 25 kg/m(2) (P = .0001). The number of surgeries, escalation of therapy, and disease distribution did not differ between the, 2 groups. A significant difference was found for time to first surgery, 252 months vs 24 months for patients with a BMI of less than 18.5 kg/m(2) VS patients with a BMI of 25 kg/m(2) or higher, respectively (P = .043). Conclusions: CD patients with a BMI of 25 kg/m(2) or higher at diagnosis were older at diagnosis and had a shorter time to first surgery than those with a BMI of less than 18.5 kg/m(2). This suggests that overweight CD patients require earlier surgical intervention and perhaps more aggressive medical therapy.