Department of Translational and Precision Medicine, Gastroenterology Unit, Policlinico Umberto I, Sapienza University, Viale del Policlinico, 155, 00161, Rome, Italy.
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Tech Coloproctol. 2020 Jun;24(6):553-562. doi: 10.1007/s10151-020-02173-1. Epub 2020 Feb 28.
Celiac disease (CD) is a systemic inflammatory disease, which primarily affects the gastrointestinal tract. It has been recently demonstrated that adipose-tissue infiltration by proinflammatory immune cells causes a chronic low-grade inflammation in obese patients. Magnetic resonance imaging (MRI) has already proved to be useful in evaluation of inflammatory states. The aim of the present study was to determine whether alterations of visceral and subcutaneous adipose tissue, identified with MRI, could serve as markers of local and systemic inflammation in patients with CD.
A pilot study was conducted comparing alterations in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in CD patients vs obese patients and healthy controls. Fifty patients were enrolled and assigned to one of the following groups: Group A: 11 active CD patients; Group B: 11 CD patients in remission; Group C: 16 obese patients; Group D: 12 healthy controls. A 3-T MRI unit was used and T2-weighted TSE images of VAT and SAT were obtained in specific regions of interest. Serum cytokine concentrations (TNF-α, IL-6, adiponectin, leptin, IL-2, IFN-γ) were determined.
There was a significant difference in VAT T2 relaxation time between Group A and B (p < 0.001), A and D (p < 0.01), B and C (p < 0.001). There was a statistically significant difference in SAT T2 relaxation time between Group A and B (p < 0.001), A and C (p < 0.05), A and D (p < 0.001), B and C (p < 0.01). In addition, VAT/SAT T2 relaxation time ratio showed a statistically significant difference between Group A and C (p < 0.05) and between Group B and C (p < 0.01). Only TNF-α and IL-6 significantly correlated with both VAT and VAT/SAT ratio in active CD.
MRI showed similar increased visceral inflammatory signals in patients with active CD and obese patients. However, subcutaneous inflammatory signals were higher in active CD than in all the other groups. These data show that there is a systemic inflammatory state in active CD, whereas chronic inflammation appears confined to VAT in obesity. These data were only partially confirmed by serological cytokine profiles, which showed less specificity than MRI.
乳糜泻（CD）是一种全身性炎症性疾病，主要影响胃肠道。最近有研究表明，促炎免疫细胞浸润脂肪组织会导致肥胖患者发生慢性低度炎症。磁共振成像（MRI）已被证明可用于评估炎症状态。本研究旨在确定 MRI 确定的内脏和皮下脂肪组织的改变是否可作为 CD 患者局部和全身炎症的标志物。
进行了一项初步研究，比较了 CD 患者与肥胖患者和健康对照者的内脏脂肪组织（VAT）和皮下脂肪组织（SAT）的改变。纳入了 50 名患者，并将其分为以下组：A 组：11 名活动性 CD 患者；B 组：11 名缓解期 CD 患者；C 组：16 名肥胖患者；D 组：12 名健康对照者。使用 3-T MRI 单元，在特定感兴趣区域获得 VAT 和 SAT 的 T2 加权 TSE 图像。测定血清细胞因子浓度（TNF-α、IL-6、脂联素、瘦素、IL-2、IFN-γ）。
A 组与 B 组（p<0.001）、A 组与 D 组（p<0.01）、B 组与 C 组（p<0.001）之间的 VAT T2 弛豫时间有显著差异。A 组与 B 组（p<0.001）、A 组与 C 组（p<0.05）、A 组与 D 组（p<0.001）、B 组与 C 组（p<0.01）之间的 SAT T2 弛豫时间有统计学显著差异。此外，A 组与 C 组（p<0.05）和 B 组与 C 组（p<0.01）之间的 VAT/SAT T2 弛豫时间比有统计学显著差异。仅 TNF-α和 IL-6 与活动性 CD 患者的 VAT 和 VAT/SAT 比值显著相关。
MRI 显示活动性 CD 患者和肥胖患者的内脏炎症信号相似增加。然而，与所有其他组相比，活动性 CD 患者的皮下炎症信号更高。这些数据表明，活动性 CD 存在全身性炎症状态，而肥胖症中的慢性炎症似乎局限于 VAT。这些数据仅部分通过血清细胞因子谱得到证实，该谱的特异性低于 MRI。
