Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2021 Sep;36(5):1221-1232. doi: 10.3904/kjim.2020.064. Epub 2020 Aug 18.
BACKGROUND/AIMS: Measures of body composition, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area (SMA), are considered important prognostic factors in chronic diseases. The association of these measures with auto-inflammatory disorders, such as anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), remains unclear. We investigated the clinical significance of VAT, SAT, and SMA in patients with AAV.
Patients with AAV subjected to chest computed tomography (CT), abdominal CT, or positron emission tomography-CT on diagnosis of AAV were evaluated. Quantitative assessment of VAT, SAT, and SMA was performed at the third lumbar vertebral level and computed by summing the pixel attenuation for tissue-specific Hounsfield units in the corresponding region. Associations of VAT, SAT, and SMA with clinical and laboratory data and clinical outcome measures were evaluated.
Of the 117 patients, 61 (52.1%) were classified as having microscopic polyangiitis, 28 (23.9%) as granulomatosis with polyangiitis, and 28 (23.9%) as eosinophilic granulomatosis with polyangiitis. VAT significantly correlated with age, weight, body mass index (BMI), and Birmingham Vasculitis Activity Score, whereas SAT correlated with weight, BMI, and creatinine levels. A significant association was found between SMA and age, height, weight, BMI, and the Five-Factor Score. Cox proportional hazards analysis showed that creatinine levels (odds ratio [OR], 1.346; 95% confidence interval [CI], 1.034 to 1.753; p = 0.027) and high VAT (OR, 7.137; 95% CI, 1.343-37.946; p = 0.021) were independently associated with all-cause mortality during follow-up.
Evaluation of VAT using CT is useful for estimating disease activity and all-cause mortality in patients with AAV.
背景/目的：身体成分的测量指标，包括内脏脂肪组织（VAT）、皮下脂肪组织（SAT）和骨骼肌面积（SMA），被认为是慢性疾病重要的预后因素。这些指标与自身炎症性疾病（如抗中性粒细胞胞浆抗体相关性血管炎（AAV））的关联尚不清楚。我们研究了 VAT、SAT 和 SMA 在 AAV 患者中的临床意义。
对诊断为 AAV 的患者进行胸部 CT、腹部 CT 或正电子发射断层扫描-CT 检查。在第三腰椎水平进行 VAT、SAT 和 SMA 的定量评估，并通过对相应区域内特定组织的 Hounsfield 单位的像素衰减进行求和计算。评估了 VAT、SAT 和 SMA 与临床和实验室数据以及临床结局指标的相关性。
在 117 例患者中，61 例（52.1%）被分类为显微镜下多血管炎，28 例（23.9%）为肉芽肿性多血管炎，28 例（23.9%）为嗜酸性肉芽肿性多血管炎。VAT 与年龄、体重、体重指数（BMI）和伯明翰血管炎活动评分显著相关，而 SAT 与体重、BMI 和肌酐水平相关。SMA 与年龄、身高、体重、BMI 和五因素评分显著相关。Cox 比例风险分析显示，肌酐水平（比值比 [OR]，1.346；95%置信区间 [CI]，1.034 至 1.753；p = 0.027）和高 VAT（OR，7.137；95% CI，1.343 至 37.946；p = 0.021）与随访期间全因死亡率独立相关。
使用 CT 评估 VAT 有助于评估 AAV 患者的疾病活动度和全因死亡率。
