骨骼肌与肌间脂肪失衡预示克罗恩病治疗失败：一种用于风险分层的影像学生物标志物

Imbalance between skeletal muscle and intermuscular fat predicts treatment failure in Crohn's disease: an imaging biomarker for risk stratification.

作者信息

Xiong Ziman, Wang Yufan, Jiang Yuchen, Shen Yaqi, Li Zhen

机构信息

Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

出版信息

Ann Med. 2025 Dec;57(1):2536756. doi: 10.1080/07853890.2025.2536756. Epub 2025 Jul 25.

DOI:10.1080/07853890.2025.2536756

PMID:40708467

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12302469/

Abstract

BACKGROUND

Sarcopenia is prevalent in Crohn's disease (CD) patients, but the prognostic value of skeletal muscle-to-intermuscular adipose tissue (IMAT) balance in penetrating CD remains unexplored.

OBJECTIVE

To determine whether skeletal muscle-IMAT imbalance predicts non-surgical treatment failure in CD.

METHODS

This retrospective study included CD patients undergoing computed tomography enterography (CTE, 2013-2022), stratified by disease behavior (penetrating vs. non-penetrating). Automated CTE segmentation algorithm quantified skeletal muscle and IMAT volumes at baseline. Skeletal muscle ratio was calculated as skeletal muscle/(skeletal muscle + IMAT). Sarcopenia was defined by the skeletal muscle area at the third lumbar vertebra. Patients received ≥1 year of non-surgical therapy, with outcomes categorized as 'maintenance therapy' or 'treatment escalation'. Cox proportional hazards analysis identified predictors of escalation; mediation analysis evaluated inflammatory-nutritional pathways.

RESULTS

Among 157 patients (penetrating: = 42; non-penetrating: = 115), treatment escalation rates were 64.3% (27/42) and 53.0% (61/115) respectively, without significant intergroup difference ( = 0.21). Skeletal muscle ratio predicted escalation in both cohorts (penetrating: AUC = 0.822 [0.673, 0.923], non-penetrating: AUC = 0.922 [0.857, 0.964]), outperforming conventional sarcopenia metrics ( = 0.002 and < 0.001). Cox regression confirmed skeletal muscle ratio as an independent protective factor (penetrating: HR = 0.098 [0.014 - 0.680], 0.02; non-penetrating: HR = 0.597 [0.442 - 0.804], 0.001; combined: HR = 0.637 [0.493 - 0.823], 0.001), while penetrating disease as risk factor (HR = 3.778 [1.281 - 11.14], = 0.02). Body mass index mediated 6.9% of the skeletal muscle ratio-treatment escalation relationship in non-penetrating CD.

CONCLUSIONS

Skeletal muscle-IMAT imbalance independently predicts treatment escalation in CD, offering superior prognostic utility to traditional sarcopenia measures.

摘要

背景

肌肉减少症在克罗恩病（CD）患者中普遍存在，但在穿透性CD中骨骼肌与肌间脂肪组织（IMAT）平衡的预后价值尚未得到探索。

目的

确定骨骼肌-IMAT失衡是否可预测CD非手术治疗失败。

方法

这项回顾性研究纳入了接受计算机断层扫描小肠造影（CTE，2013 - 2022年）的CD患者，按疾病行为（穿透性与非穿透性）分层。自动CTE分割算法在基线时量化骨骼肌和IMAT体积。计算骨骼肌比率为骨骼肌/（骨骼肌 + IMAT）。根据第三腰椎水平的骨骼肌面积定义肌肉减少症。患者接受≥1年的非手术治疗，结局分为“维持治疗”或“治疗升级”。Cox比例风险分析确定升级的预测因素；中介分析评估炎症 - 营养途径。

结果

在157例患者中（穿透性：n = 42；非穿透性：n = 115），治疗升级率分别为64.3%（27/42）和53.0%（61/115），组间无显著差异（P = 0.21）。骨骼肌比率在两个队列中均能预测升级（穿透性：AUC = 0.822 [0.673, 0.923]，非穿透性：AUC = 0.922 [0.857, 0.964]），优于传统的肌肉减少症指标（P = 0.002和P < 0.001）。Cox回归证实骨骼肌比率是一个独立的保护因素（穿透性：HR = 0.098 [0.014 - 0.680]，P = 0.02；非穿透性：HR = 0.597 [0.442 - 0.804]，P = 0.001；合并：HR = 0.637 [0.493 - 0.823]，P = 0.001），而穿透性疾病是危险因素（HR = 3.778 [1.281 - 11.14]，P = 0.02）。在非穿透性CD中，体重指数介导了骨骼肌比率 - 治疗升级关系的6.9%。