Csontos Ágnes Anna, Molnár Andrea, Piri Zsolt, Katona Balázs, Dakó Sarolta, Pálfi Erzsébet, Miheller Pál
2nd Department of Medicine; Budapest, Hungary.
School of PhD Studies, Pathological Sciences, Health Science Research, Budapest, Hungary.
J Gastrointestin Liver Dis. 2016 Mar;25(1):49-56. doi: 10.15403/jgld.2014.1121.251.tnf.
Patients suffering from inflammatory bowel disease (IBD) are at a high risk of malnutrition and retain an altered body composition. We hypothesized that anti-tumor necrosis factor (anti-TNF) alpha therapy may improve dietary intake and have a beneficial influence on body composition in these patients.
Our study involved 40 IBD outpatients (33 Crohn's disease, 7 ulcerative colitis); 24 of these received adalimumab (160/80/40EOW) and 16 were treated with infliximab (5 mg/kg at week 0, 2, 6, and subsequently every 8 weeks). Body composition was measured with bioelectrical impedance analysis, while dietary intake was recorded prior to initiating biologicals and 3 months afterwards. Body composition indexes: fat-free mass index [FFMI], body fat mass index [BFMI]) were calculated in kg/m2.
Baseline BMI (kg/m2) and muscle parameters increased significantly at the end of the observational period (BMI: 23.81+/-7.19 vs. 24.52+/-7.34, p<0.001; FFMI: 17.64+/-3.00 vs. 18.14+/-3.08, p<0.001; at week 0 vs. 12, respectively). However, no significant changes were detected in the fat parameters (BFMI: 6.21+/-5.20 vs. 6.44+/-5.27, respectively). We found no significant difference between the effects of adalimumab vs. infliximab on body composition (deltaFFMI: 0.55+/-0.82 vs. 0.43+/-0.69; deltaBFMI: 0.23+/-0.85 vs. 0.21+/-1.01, respectively). No significant difference was observed in the extent of changes in parameters whether the patients were on corticosteroids (n=15) or not (n=25) at week 0 (deltaFFMI: 0.44+/-0.84 vs 0.59+/-0.72; deltaBFMI: 0.36+/-1.12 vs. 0.09+/-0.71, respectively).
Our findings suggest that muscle parameters improved during the anti-TNF induction therapy, while fat parameters did not change significantly. Thus, induction anti-TNF therapy might have a beneficial effect on body composition.
炎症性肠病（IBD）患者存在营养不良的高风险，且身体成分发生改变。我们推测抗肿瘤坏死因子（anti-TNF）α治疗可能会改善这些患者的饮食摄入，并对身体成分产生有益影响。
我们的研究纳入了40例IBD门诊患者（33例克罗恩病，7例溃疡性结肠炎）；其中24例接受阿达木单抗治疗（初始剂量160mg，随后80mg、40mg，每8周一次），16例接受英夫利昔单抗治疗（第0、2、6周静脉滴注5mg/kg，之后每8周一次）。采用生物电阻抗分析法测量身体成分，在开始生物制剂治疗前及治疗3个月后记录饮食摄入情况。计算身体成分指数：无脂肪质量指数[FFMI]、体脂肪质量指数[BFMI]，单位为kg/m²。
观察期末，基线体重指数（BMI，kg/m²）和肌肉参数显著增加（BMI：23.81±7.19 vs. 24.52±7.34，p<0.001；FFMI：17.64±3.00 vs. 18.14±3.08，p<0.001；分别为第0周和第12周时的数据）。然而，脂肪参数未发现显著变化（BFMI：分别为6.21±5.20 vs. 6.44±5.27）。我们发现阿达木单抗与英夫利昔单抗对身体成分的影响无显著差异（ΔFFMI：0.55±0.82 vs. 0.43±0.69；ΔBFMI：0.23±0.85 vs. 0.21±1.01）。第0周时，无论患者是否使用糖皮质激素（n = 15），各参数变化程度均无显著差异（ΔFFMI：0.44±0.84 vs 0.59±0.72；ΔBFMI：0.36±1.12 vs. 0.09±0.71）。
我们的研究结果表明，在anti-TNF诱导治疗期间肌肉参数有所改善，而脂肪参数无显著变化。因此，诱导性anti-TNF治疗可能对身体成分有有益影响。
