肌肉减少症是接受生物制剂治疗的克罗恩病患者内镜缓解的负预测因素。
Sarcopenia is a negative predictive factor for endoscopic remission in patients with Crohn's disease treated with biologics.
机构信息
Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy; Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy; Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
出版信息
Dig Liver Dis. 2023 Jul;55(7):865-871. doi: 10.1016/j.dld.2023.02.017. Epub 2023 Mar 14.
BACKGROUND
Sarcopenia has been associated with poor prognosis in chronic diseases.
AIMS
To investigate the role of sarcopenia in predicting clinical and endoscopic outcomes in patients with Crohn's disease (CD).
METHODS
Consecutive CD patients who started biologics between 2014 and 2020 and underwent abdominal magnetic resonance or computed tomography within 6 months from the beginning of the biological therapy were enroled. Sarcopenia was defined as Psoas Muscle Index (PMI) lower than 5.4 cm²/m² (men) and 3.56 cm²/m² (women). Univariate and multivariate analyses were used to evaluate whether sarcopenia could predict steroid-free clinical remission (SFCR), endoscopic remission (ER), hospitalisation and surgery after 12 months of therapy.
RESULTS
358 patients were included. Sarcopenia was found in 18.2% of patients, and it was associated with a lower rate of ER (14.8% vs 47.7%; p = 0.002) after 12 months of therapy, while it was not associated with SFCR (65.1% vs 70.1%; p = 0.435), hospitalisation (9.2% vs 7.8%; p = 0.801) and surgery (3.1% vs 6.1%; p = 0.549). Sarcopenia was identified as a predictor of lack of ER (odds ratio [OR]=5.2; p = 0.006), as well as smoking (OR=2.5; p = 0.028) and perianal disease (OR=2.6; p = 0.020).
CONCLUSION
Sarcopenia is a negative prognostic factor for ER in CD patients treated with biologics.
背景
肌肉减少症与慢性疾病的不良预后相关。
目的
研究肌肉减少症在预测克罗恩病（CD）患者临床和内镜结局中的作用。
方法
连续纳入 2014 年至 2020 年期间开始接受生物制剂治疗且在生物治疗开始后 6 个月内接受腹部磁共振或计算机断层扫描的 CD 患者。肌肉减少症定义为比目鱼肌指数（PMI）男性低于 5.4 cm²/m²，女性低于 3.56 cm²/m²。采用单因素和多因素分析评估肌肉减少症是否可以预测治疗 12 个月后的无激素临床缓解（SFCR）、内镜缓解（ER）、住院和手术。
结果
共纳入 358 例患者，18.2%的患者存在肌肉减少症，与治疗 12 个月后 ER 率较低相关（14.8% vs 47.7%，p=0.002），但与 SFCR 无关（65.1% vs 70.1%，p=0.435）、住院（9.2% vs 7.8%，p=0.801）和手术（3.1% vs 6.1%，p=0.549）。肌肉减少症被确定为 ER 缺乏的预测因素（比值比[OR]=5.2，p=0.006），以及吸烟（OR=2.5，p=0.028）和肛周疾病（OR=2.6，p=0.020）。
结论
肌肉减少症是接受生物制剂治疗的 CD 患者 ER 的不良预后因素。
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