克罗恩病患者内脏脂肪组织与疾病行为和活动的相关性分析

Correlation analysis among visceral adipose tissue and disease behavior and activity in patients with Crohn's disease

目的:探讨内脏脂肪组织与克罗恩病(CD)行为和活动的关系。方法:回顾性纳入2019年7月至2021年5月在武汉大学中南医院住院期间确诊为CD并行CT小肠造影(CTE)检查的104例患者。采用CD患者第三腰椎(L3)层面CT图像定量测量内脏脂肪组织(VAT)和皮下脂肪组织(SAT)。肠系膜脂肪指数(MFI)定义为内脏与皮下脂肪组织面积的比值。皮下脂肪指数(SAI)和内脏脂肪指数(VAI)通过用各自脂肪组织面积除以身高的平方计算得出。同时对疾病行为和活动度进行分析。结果:将CD患者分为非复杂组(非狭窄非穿透型)和复杂组(狭窄型/穿透型)。比较两组MFI、SAT、VAT、SAI、VAI的差异无统计学意义(P>0.05)。复杂表型患者体质量指数(BMI)较低,病程较长(P<0.05)。与缓解期患者相比,活动期患者的MFI显著升高(P=0.001)。MFI与C-反应蛋白(CRP)、血小板、血沉(ESR)呈正相关,相关系数分别为0.431、0.242、0.225(P<0.05)。缓解期CD患者BMI、SAT、SAI明显高于活动期(P<0.01)。BMI与SAI(r=0.656,P<0.001)、VAI(r=0.606,P<0.001)高度相关。SAI与白蛋白呈正相关(r=0.250,P=0.01),与CRP呈负相关(r=-0.311,P=0.001)。结论:克罗恩病患者肠系膜脂肪指数(内脏脂肪组织与皮下脂肪组织面积之比)与疾病活动有关。

Objective:To explore the relationship between visceral adipose tissue and Crohn's disease(CD)disease behavior and activity.Methods:One hundred and four patients with confirmed CD diagnose and computed tomography enterography(CTE)scans were retrospectively enrolled during hospitalization between July 2019 and May 2021 in Zhongnan Hospital of Wuhan University.CT images of the third lumbar spine(L3)of CD patients were used to quantify visceral adipose tissue(VAT)and subcu-taneous adipose tissue(SAT).Mesenteric fat index(MFI),defined as the ratio of visceral to subcutaneous adipose tissue area,subcutaneous adipose index(SAI),and visceral adipose index(VAI)were calculated by dividing each type of tissue area by height's square.The patients'disease behavior and activity were also analyzed.Results:CD patients were divided into non-complicated(non-stricturing,non-penetrating disease)and complicated phenotypes(stricturing/penetrating disease).However,there was no significant difference between the two groups with respect to MFI,SAT VAT,SAI,and VAI(P>0.05).Additionally,patients in complicated phenotype had lower body mass index(BMI)and longer course of disease(P<0.05).MFI were significantly higher in patients during active period as compared with those in remission(P=0.001).There were positive correlations between MFI and C-reactive protein(CRP),platelet,or erythrocyte sedimentation rate(ESR),and the correlation coefficient was 0.431,0.242,and 0.225,respectively(P<0.05).Moreover,BMI,SAT,and SAI in CD patients during remission were significantly higher than those in the active period(P<0.01).BMI was highly related to SAT(r=0.656,P<0.001)and VAI(r=0.606,P<0.001).SAI was positively correlated with albumin(r=0.250,P=0.01)and negatively correlated with CRP(r=-0.311,P=0.001).Conclusion:Mesenteric fat index(the ratio of visceral to subcutaneous adipose tissue area)in Crohn's disease patients is associated with disease activity.