Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Crohns Colitis. 2018 Aug 29;12(9):1036-1041. doi: 10.1093/ecco-jcc/jjy064.
Acute severe ulcerative colitis [ASUC] affects one in four patients with UC. Clinical parameters perform modestly in predicting the need for rescue therapy. Sarcopenia and visceral adiposity predict natural history in Crohn's disease, but the role of such metabolic factors on ASUC outcomes is unknown. The aim of this study was to define the effect of sarcopenia and visceral adiposity on outcomes in ASUC.
We studied patients hospitalized for ASUC who underwent an abdominal CT scan during the hospitalization. Quantification of skeletal muscle mass and visceral adiposity was performed by radiologists blinded to the outcome. Sarcopenia was defined as a skeletal muscle index of <55 cm2/m2 for men and <39 cm2/m2 for women. The primary outcome of interest was need for medical or surgical rescue therapy.
Our study included 89 patients with ASUC, among whom 39 [43.8%] patients required medical rescue therapy or surgery. Two-thirds of the cohort [70%] met the definition of sarcopenia [81% men, 48% women]. Patients with sarcopenia had similar disease characteristics and laboratory parameters to those with a normal muscle mass. However, a larger proportion of patients with sarcopenia required rescue therapy compared with those without (56% vs 28%, multivariable odds ratio [OR] 3.98, 95% confidence interval [CI] 1.12-14.1). Neither visceral [p = 0.23] nor subcutaneous adiposity [p = 0.53] predicted the need for rescue therapy.
Sarcopenia as determined on abdominal CT was a novel predictor of need for rescue therapy in hospitalized UC patients.
急性重度溃疡性结肠炎（ASUC）影响四分之一的 UC 患者。临床参数在预测需要挽救性治疗方面表现欠佳。在克罗恩病中，肌肉减少症和内脏肥胖预测其自然病程，但这些代谢因素对 ASUC 结局的作用尚不清楚。本研究旨在定义肌肉减少症和内脏肥胖症对 ASUC 结局的影响。
我们研究了因 ASUC 住院的患者，这些患者在住院期间接受了腹部 CT 扫描。放射科医生对结果进行了盲法评估，以对骨骼肌量和内脏脂肪量进行量化。肌肉减少症定义为男性骨骼肌指数<55 cm2/m2，女性<39 cm2/m2。主要观察终点是是否需要药物或手术挽救性治疗。
我们的研究纳入了 89 例 ASUC 患者，其中 39 例[43.8%]患者需要药物挽救性治疗或手术。队列中有三分之二[70%]的患者符合肌肉减少症的定义[81%的男性，48%的女性]。与肌肉量正常的患者相比，肌肉减少症患者的疾病特征和实验室参数相似。然而，需要挽救性治疗的肌肉减少症患者比例高于无肌肉减少症患者（56% vs 28%，多变量比值比[OR]3.98，95%置信区间[CI]1.12-14.1）。内脏[P=0.23]和皮下脂肪[P=0.53]均不能预测是否需要挽救性治疗。
腹部 CT 确定的肌肉减少症是住院 UC 患者需要挽救性治疗的新预测因素。
