Bamba Shigeki, Sasaki Masaya, Takaoka Azusa, Takahashi Kenichiro, Imaeda Hirotsugu, Nishida Atsushi, Inatomi Osamu, Sugimoto Mitsushige, Andoh Akira
Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
Division of Clinical Nutrition, Shiga University of Medical Science, Otsu, Shiga, Japan.
PLoS One. 2017 Jun 23;12(6):e0180036. doi: 10.1371/journal.pone.0180036. eCollection 2017.
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.
骨骼肌体积与炎症性肠病（IBD）患者预后之间的关系尚未明确。我们对72例因疾病加重入院的IBD患者进行了一项回顾性研究。我们纳入了接受过腹部计算机断层扫描的IBD患者，并评估了营养指标，如小野寺预后营养指数（O-PNI）和控制营养状况（CONUT）指数。第三腰椎（L3）水平的骨骼肌横截面积与身高平方之比的L3骨骼肌指数（SMI）用于识别肌肉减少症。在所有IBD患者中，42%观察到肌肉减少症（克罗恩病（CD）患者为37%，溃疡性结肠炎（UC）患者为48%）。在UC患者中，O-PNI和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。使用Cox回归模型进行的多变量分析表明，肌肉减少症的存在（P = 0.015）和疾病类型（CD或UC）（P = 0.007）是预测肠道切除的重要因素。使用Kaplan-Meier方法和对数秩检验对肌肉减少症患者与所有IBD患者（P = 0.003）以及CD患者分层分析（P = 0.001），肌肉减少症患者的累积无手术生存率显著低于所有IBD患者。L3骨骼肌面积是CD患者肠道切除的预后因素。
