内脏脂肪与克罗恩病英夫利昔单抗治疗的黏膜愈合相关。

Visceral Fat Is Associated With Mucosal Healing of Infliximab Treatment in Crohn's Disease.

机构信息

Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.

出版信息

Dis Colon Rectum. 2018 Jun;61(6):706-712. doi: 10.1097/DCR.0000000000001074.

DOI:10.1097/DCR.0000000000001074

PMID:29722729

Abstract

BACKGROUND

Visceral fat is the pathogenesis of Crohn's disease and is associated with disease status.

OBJECTIVE

This study aimed to evaluate the effect of the visceral fat on mucosal healing in patients with Crohn's disease after infliximab induction therapy DESIGN:: This was a retrospective study.

SETTINGS

The study was conducted in a tertiary referral hospital.

PATIENTS

Between 2011 and 2017, 97 patients with Crohn's disease with the presence of ulcers underwent infliximab therapy.

MAIN OUTCOME MEASURES

We studied them retrospectively. Mucosal healing was the end point. Patients composed 2 groups: mucosal healing and no mucosal healing. Univariate, multivariate, and receiver operating characteristic curve analyses determined the predictive value of the visceral fat area.

RESULTS

Univariate analysis showed a statistically significant difference in the smoking history between the groups. Mucosal healing rates after infliximab were lower among active smokers (p = 0.022). Healed patients had significantly less visceral fat area before therapy (47.76 ± 4.94 vs 75.88 ± 5.55; p = 0.000) and a lower mesenteric fat index (0.52 ± 0.04 vs 0.89 ± 0.07; p = 0.000). There was no significant difference in the subcutaneous fat area (87.39 ± 5.01 vs 93.31 ± 6.95; p = 0.500). Multivariate analysis showed that only visceral fat area (OR = 0.978 (95% CI, 0.964-0.992); p = 0.002) and smoking history (OR = 0.305 (95% CI, 0.089-0.996); p = 0.041) were independent factors for mucosal healing. Receiver operating characteristic curve analysis showed predictive cutoff values of 61.5 cm and 0.62 for visceral fat area and mesenteric fat index.

LIMITATIONS

This was a retrospective study.

CONCLUSIONS

There was an association between increased visceral fat area and attenuated mucosal healing after infliximab therapy in biologically naive patients with Crohn's disease, indicating a need for earlier increased infliximab doses among patients with increased visceral fat. See Video Abstract at http://links.lww.com/DCR/A590.

摘要

背景

内脏脂肪是克罗恩病的发病机制，与疾病状态有关。

目的

本研究旨在评估内脏脂肪对接受英夫利昔单抗诱导治疗的克罗恩病患者黏膜愈合的影响。

设计

这是一项回顾性研究。

设置

研究在一家三级转诊医院进行。

患者

2011 年至 2017 年间，97 例存在溃疡的克罗恩病患者接受了英夫利昔单抗治疗。

主要观察指标

我们对这些患者进行了回顾性研究。黏膜愈合是终点。患者分为黏膜愈合组和非黏膜愈合组。单变量、多变量和受试者工作特征曲线分析确定了内脏脂肪面积的预测价值。

结果

单变量分析显示，两组间吸烟史存在统计学显著差异。在吸烟者中，英夫利昔单抗治疗后的黏膜愈合率较低（p = 0.022）。治愈患者在治疗前的内脏脂肪面积明显较小（47.76±4.94 与 75.88±5.55；p = 0.000），肠系膜脂肪指数也较低（0.52±0.04 与 0.89±0.07；p = 0.000）。皮下脂肪面积无显著差异（87.39±5.01 与 93.31±6.95；p = 0.500）。多变量分析显示，只有内脏脂肪面积（OR = 0.978（95%CI，0.964-0.992）；p = 0.002）和吸烟史（OR = 0.305（95%CI，0.089-0.996）；p = 0.041）是黏膜愈合的独立因素。受试者工作特征曲线分析显示，内脏脂肪面积和肠系膜脂肪指数的预测截断值分别为 61.5cm 和 0.62。