肥胖对克罗恩病患者抗肿瘤坏死因子-α水平和应答丧失的影响。
The Effect of Adiposity on Anti-Tumor Necrosis Factor-Alpha Levels and Loss of Response in Crohn's Disease Patients.
机构信息
Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, Australia.
Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, Australia.
出版信息
Clin Transl Gastroenterol. 2020 Sep;11(9):e00233. doi: 10.14309/ctg.0000000000000233.
INTRODUCTION
A high body mass index is known to adversely affect antitumor necrosis factor-alpha trough levels and secondary loss of response (SLOR) in patients with Crohn's disease. We hypothesize that high levels of adiposity negatively affect these outcomes and aimed to determine if this relationship exists.
METHODS
We performed a retrospective cross-sectional study of 69 patients with Crohn's disease from two tertiary inflammatory bowel disease centers between February 1, 2015, and June 30, 2018. Primary responders to infliximab (IFX) or adalimumab (ADA) who had a trough level performed within 6 months of CT or MRI scan and at least 12 months of clinical follow-up were eligible for inclusion. Body composition as measured on CT/MRI scans were correlated with trough concentration and time SLOR. Multivariate adjustments were made for established risk factors known to affect trough levels and SLOR.
RESULTS
Of 69 included patients, 44 (63.8%) and 25 (36.2%) patients received IFX and ADA, respectively. Multivariate analysis revealed that IFX trough concentrations were inversely correlated with visceral fat area (-0.02 [-0.04, -0.003], P = 0.03), visceral fat index (-0.07 [-0.12, -0.01], P = 0.02) and visceral fat: skeletal muscle area ratio (-3.81 [-7.13, -0.50], P = 0.03), but not body mass index (-0.23 [-0.52, 0.06], P = 0.11). No predictive factors were found for ADA. Increased total adipose area was associated with an increased risk of SLOR in ADA-treated patients, but not IFX-treated patients (hazard ratio = 1.01 [1.002, 1.016], P = 0.011).
DISCUSSION
Visceral adiposity is an important predictor of IFX trough levels, and high total adiposity predicts for SLOR to ADA.
简介
已知肥胖指数高会影响克罗恩病患者的肿瘤坏死因子-α 谷浓度和继发无应答（SLOR）。我们假设高水平的肥胖会对这些结果产生负面影响，并旨在确定这种关系是否存在。
方法
我们对 2015 年 2 月 1 日至 2018 年 6 月 30 日期间，来自两个三级炎症性肠病中心的 69 名克罗恩病患者进行了回顾性横断面研究。主要对英夫利昔单抗（IFX）或阿达木单抗（ADA）有应答的患者，在 CT 或 MRI 扫描后 6 个月内进行了谷浓度检测，且至少有 12 个月的临床随访，符合纳入标准。通过 CT/MRI 扫描测量的身体成分与谷浓度和 SLOR 时间相关。对已知影响谷浓度和 SLOR 的既定危险因素进行了多变量调整。
结果
69 名纳入患者中，分别有 44 名（63.8%）和 25 名（36.2%）患者接受 IFX 和 ADA。多变量分析显示，IFX 谷浓度与内脏脂肪面积呈负相关（-0.02 [-0.04，-0.003]，P = 0.03），与内脏脂肪指数（-0.07 [-0.12，-0.01]，P = 0.02）和内脏脂肪：骨骼肌面积比（-3.81 [-7.13，-0.50]，P = 0.03），但与体重指数（-0.23 [-0.52，0.06]，P = 0.11）无关。未发现 ADA 的预测因素。在接受 ADA 治疗的患者中，总脂肪面积增加与 SLOR 的风险增加相关，但在接受 IFX 治疗的患者中则无此相关性（风险比=1.01 [1.002，1.016]，P = 0.011）。
讨论
内脏肥胖是 IFX 谷浓度的重要预测指标，而总脂肪过多预示着 ADA 的 SLOR。
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