Frivolt Klara, Hetterich Holger, Schwerd Tobias, Hajji Mohammad-Samer, Bufler Philip, Coppenrath Eva, Koletzko Sibylle
Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany.
Department of Pediatrics, Comenius University Medical School, Bratislava, Slovakia.
J Pediatr Gastroenterol Nutr. 2017 Dec;65(6):633-638. doi: 10.1097/MPG.0000000000001593.
Recent evidence points toward an active immunological role of intra-abdominal adipose tissue in Crohn disease (CD). We quantified the abdominal adipose tissue compartments using magnetic resonance imaging (MRI) in 27 pediatric patients with CD compared with 14 controls undergoing MRI examination for other reasons.
Total (TAAT), subcutaneous (SCAT) and intra-abdominal (IAAT) adipose tissue areas were measured by semiautomatic segmentation on a transverse slice centered on the umbilicus (mean ± standard deviation in square centimeter) using standard T1-weighted sequences. IAAT/TAAT and IAAT/height ratios were calculated and analyzed for associations with disease duration, phenotype, or therapy.
Patients with CD (median age 15.0 years, range 7.7-17.9, 18/27 boys, median disease duration 29 months, range 0-136) compared to controls (median age 13.9 years, range 3.3-17.8, 4/14 boys) had higher IAAT area (42.3 ± 21.0 vs 28.7 ± 11.6, P = 0.0494) but similar SCAT and TAAT areas (104.6 ± 72.8 vs 96.5 ± 50.8, P = 0.8170 and 146.9 ± 87.3 vs 125.3 ± 61.5, P = 0.7417, respectively). IAAT/TAAT ratio was higher in patients with CD compared to controls (0.32 ± 0.10 vs 0.24 ± 0.04, P = 0.0081). Patients with disease duration >2 years (n = 14) had higher IAAT/TAAT ratio than those with shorter disease and controls (0.35 ± 0.10 vs 0.28 ± 0.08, P = 0.0288 and 0.24 ± 0.04, P = 0.0009, respectively). In these patients, increased IAAT/height ratio was associated with complicated disease (P = 0.043, r = 0.573). No association was found between IAAT/TAAT ratio and actual disease activity or therapy.
IAAT is increased in pediatric CD and correlates with disease duration. Assessment of IAAT accumulation may be considered in future MRI scores for inflammation and bowel damage in CD and during follow-up of different therapeutic interventions.
近期证据表明，腹腔内脂肪组织在克罗恩病（CD）中发挥着积极的免疫作用。我们对27例儿科CD患者的腹部脂肪组织区域进行了磁共振成像（MRI）定量分析，并与14例因其他原因接受MRI检查的对照者进行比较。
使用标准T1加权序列，通过半自动分割在以脐部为中心的横断面上测量总腹部脂肪组织（TAAT）、皮下脂肪组织（SCAT）和腹腔内脂肪组织（IAAT）的面积（平方厘米，均值±标准差）。计算IAAT/TAAT和IAAT/身高比值，并分析其与疾病持续时间、表型或治疗的相关性。
与对照组（中位年龄13.9岁，范围3.3 - 17.8岁，4/14为男性）相比，CD患者（中位年龄15.0岁，范围7.7 - 17.9岁，18/27为男性，中位疾病持续时间29个月，范围0 - 136个月）的IAAT面积更高（42.3±21.0 vs 28.7±11.6，P = 0.0494），但SCAT和TAAT面积相似（104.6±72.8 vs 96.5±50.8，P = 0.8170；146.9±87.3 vs 125.3±61.5，P = 0.7417）。与对照组相比，CD患者的IAAT/TAAT比值更高（0.32±0.10 vs 0.24±0.04，P = 0.0081）。疾病持续时间>2年的患者（n = 14）的IAAT/TAAT比值高于疾病持续时间较短的患者及对照组（分别为0.35±0.10 vs 0.28±0.08，P = 0.0288；0.24±0.04，P = 0.0009）。在这些患者中，IAAT/身高比值增加与复杂疾病相关（P = 0.043，r = 0.573）。未发现IAAT/TAAT比值与实际疾病活动或治疗之间存在关联。
儿科CD患者的IAAT增加，且与疾病持续时间相关。在未来用于评估CD炎症和肠损伤的MRI评分以及不同治疗干预的随访过程中，可考虑评估IAAT蓄积情况。
