Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta, Edmonton, AB, Canada.
Inflamm Bowel Dis. 2018 Mar 19;24(4):861-870. doi: 10.1093/ibd/izx070.
Crohn's disease (CD) patients who undergo ileocolonic resection frequently have disease recurrence. The aim of this preliminary study was to identify urinary metabolomic profiles associated with disease recurrence in order to identify underlying mechanisms of recurrence and possible disease biomarkers.
Biopsies from the neoterminal ileum were collected from CD patients (n = 38) after ileocolonic resection in order to assess mucosa-associated microbiota using 16S rRNA multitag pyrosequencing. Urine samples were collected, and metabolomic profiling was done using high-resolution nuclear magnetic resolution spectroscopy and a combined direct infusion liquid chromatography tandem mass spectrometry. The Rutgeerts scoring system was used to assess endoscopic postoperative recurrence of CD.
There were 28 (73.7%) patients with endoscopic CD recurrence. CD patients who were in endoscopic remission had a higher abundance of Bacteroidetes and lower abundance of Fusobacteria and Proteobacteria in comparison with CD patients who had endoscopic recurrence. In addition, metabolomic profiling could also discriminate between these 2 groups of patients. Endoscopic recurrence was associated with increased concentration of urinary levoglucosan. Rutgeerts score was positively correlated with levoglucosan and propylene glycol levels.
CD patients who present with endoscopic disease recurrence after surgery have a unique urinary metabolomic fingerprint that can differentiate them from CD patients who are in endoscopic remission after ileocolonic resection. In addition, mucosal-associated microbiota in CD patients with or without disease recurrence after surgery differs and correlates with some urinary metabolites.
接受回肠结肠切除术的克罗恩病（CD）患者常有疾病复发。本初步研究旨在确定与疾病复发相关的尿代谢组学特征，以确定复发的潜在机制和可能的疾病生物标志物。
从回肠结肠切除术后的 CD 患者（n=38）的新末端回肠中采集活检组织，使用 16S rRNA 多标签焦磷酸测序评估黏膜相关微生物群。收集尿液样本，并使用高分辨率核磁共振波谱和组合直接进样液相色谱串联质谱进行代谢组学分析。使用 Rutgeerts 评分系统评估 CD 的内镜术后复发情况。
28 例（73.7%）患者内镜下 CD 复发。与内镜下复发的 CD 患者相比，内镜缓解的 CD 患者的拟杆菌门丰度更高，梭杆菌门和变形菌门丰度更低。此外，代谢组学分析也可以区分这两组患者。内镜复发与尿液左旋葡聚糖浓度升高有关。Rutgeerts 评分与左旋葡聚糖和丙二醇水平呈正相关。
手术后出现内镜疾病复发的 CD 患者具有独特的尿代谢组学特征，可以将其与内镜缓解的回肠结肠切除术后 CD 患者区分开来。此外，手术后有或无疾病复发的 CD 患者的黏膜相关微生物群不同，与某些尿液代谢物相关。
