Yuan Gang, He Yao, Cao Qing-Hua, Tang Mi-Mi, Xie Zong-Lin, Qiu Yun, Zeng Zhi-Rong, Peng Sui, Chen Min-Hu
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Gastroenterol Rep (Oxf). 2022 Aug 27;10:goac044. doi: 10.1093/gastro/goac044. eCollection 2022.
This study explored the diagnostic performance of visceral adiposity to predict the degree of intestinal inflammation and fibrosis.
The patients with Crohn's disease (CD) who underwent surgical small bowel resection at the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between January 2007 and December 2017 were enrolled. We evaluated the intestinal imaging features of computed tomography enterography (CTE), including mesenteric inflammatory fat stranding, the target sign, mesenteric hypervascularity, bowel wall thickening, lymphadenopathy, stricture diameter, and maximal upstream diameter. We used A.K. software (Artificial Intelligence Kit, version 1.1) to calculate the visceral fat (VF) and subcutaneous fat (SF) volumes at the third lumbar vertebra level. Pathological tissue information was recorded. Diagnostic models were established based on the multivariate regression analysis results, and their effectiveness was evaluated by area under the curve (AUC) and decision curve analyses.
Overall, 48 patients with CD were included in this study. The abdominal VF/SF volume ratio (odds ratio, 1.20; 95% confidence interval, 1.05-1.38; =0.009) and the stenosis diameter/upstream intestinal dilatation diameter (ND) ratio (odds ratio, 0.90; 95% confidence interval, 0.82-0.99; =0.034) were independent risk factors for the severe fibrosis of the small intestine. The AUC values of the VF/SF ratio, the ND ratio, and their combination were 0.760, 0.673, and 0.804, respectively. The combination of the VS/SF volume ratio and ND ratio achieved the highest net benefit on the decision curve.
The VF volume on CTE can reflect intestinal fibrosis. The combination of the VF/SF volume ratio and ND ratio of CD patients assessed using CTE can help predict severe fibrosis stenosis of the small intestine.
本研究探讨内脏脂肪过多对预测肠道炎症和纤维化程度的诊断效能。
纳入2007年1月至2017年12月在中山大学附属第一医院（中国广州）接受手术小肠切除的克罗恩病（CD）患者。我们评估了计算机断层扫描小肠造影（CTE）的肠道影像特征，包括肠系膜炎性脂肪浸润、靶征、肠系膜血管增多、肠壁增厚、淋巴结肿大、狭窄直径和最大上游直径。我们使用A.K.软件（人工智能套件，版本1.1）计算第三腰椎水平的内脏脂肪（VF）和皮下脂肪（SF）体积。记录病理组织信息。基于多变量回归分析结果建立诊断模型，并通过曲线下面积（AUC）和决策曲线分析评估其有效性。
总体而言，本研究纳入了48例CD患者。腹部VF/SF体积比（比值比，1.20；95%置信区间，1.05 - 1.38；P = 0.009）和狭窄直径/上游肠扩张直径（ND）比（比值比，0.90；95%置信区间，0.82 - 0.99；P = 0.034）是小肠严重纤维化的独立危险因素。VF/SF比、ND比及其组合的AUC值分别为0.760、0.673和0.804。VF/SF体积比和ND比的组合在决策曲线上实现了最高的净效益。
CTE上的VF体积可反映肠道纤维化。使用CTE评估的CD患者的VF/SF体积比和ND比的组合有助于预测小肠严重纤维化狭窄。
