Campbell James P, Teigen Levi, Manski Scott, Blumhof Brian, Guglielmo Flavius F, Shivashankar Raina, Shmidt Eugenia
Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
Inflamm Bowel Dis. 2022 Dec 1;28(12):1844-1850. doi: 10.1093/ibd/izac013.
Sarcopenia is common in inflammatory bowel disease (IBD); however, estimates of its prevalence and impact on clinical outcomes are variable. This study sought to compare the prevalence of sarcopenia in IBD patients starting new biologics vs patients undergoing IBD surgeries, and its association with common clinical predictors of nutritional status, adverse events, and clinical outcomes.
This was a multicenter retrospective cohort study of IBD patients who had a computed tomography (CT) scan within 6 months prior to new biologic initiation (medical cohort) or IBD surgery (surgery cohort). The lowest sex-specific quartile of the total psoas area index at the L3 level defined sarcopenia. Prevalence and predictors of sarcopenia, performance of common clinical nutritional markers, and association with adverse events and clinical outcomes at 1 year were determined.
A total of 156 patients were included (48% medical cohort, 52% surgery cohort). Sarcopenia was more common in the surgery cohort (32% vs 16%; P < .02). In the medical cohort, sarcopenia predicted need for surgery at 1 year (odds ratio, 4.75; 95% confidence interval, 1.10-20.57; P = .04). Low albumin and body mass index (BMI) were associated with the presence of sarcopenia; however, 24% of sarcopenic patients had both normal BMI and albumin.
Sarcopenia is more prevalent among IBD patients undergoing surgery and predicts the need for surgery in patients starting new biologic therapy. Low albumin and BMI were similar between cohorts, suggesting a unique role for sarcopenia as a relevant clinical marker of lean muscle mass depletion for surgically and medically treated IBD patients.
肌肉减少症在炎症性肠病（IBD）中很常见；然而，其患病率估计以及对临床结局的影响存在差异。本研究旨在比较开始使用新生物制剂的IBD患者与接受IBD手术的患者中肌肉减少症的患病率，以及其与营养状况、不良事件和临床结局的常见临床预测因素之间的关联。
这是一项针对IBD患者的多中心回顾性队列研究，这些患者在开始新生物制剂治疗前6个月内（药物队列）或IBD手术前6个月内（手术队列）进行了计算机断层扫描（CT）。L3水平的总腰大肌面积指数的性别特异性最低四分位数定义为肌肉减少症。确定了肌肉减少症的患病率和预测因素、常见临床营养指标的表现以及与1年时不良事件和临床结局的关联。
共纳入156例患者（48%为药物队列，52%为手术队列）。肌肉减少症在手术队列中更为常见（32%对16%；P <.02）。在药物队列中，肌肉减少症预测1年内需要手术（比值比，4.75；95%置信区间，1.10 - 20.57；P =.04）。低白蛋白和体重指数（BMI）与肌肉减少症的存在相关；然而，24%的肌肉减少症患者BMI和白蛋白均正常。
肌肉减少症在接受手术的IBD患者中更为普遍，并预测开始新生物治疗的患者需要手术。各队列之间低白蛋白和BMI相似，这表明肌肉减少症作为手术和药物治疗的IBD患者瘦肌肉量消耗的相关临床标志物具有独特作用。
