克罗恩病合并肌少症的简易诊断指标分析  

Analysis of simple diagnostic indexes of Crohn′s disease complicated with sarcopenia

作　　者：沈玉婷 周培 顾栋婷 沈卫东[1] Shen Yuting;Zhou Pei;Gu Dongting;Shen Weidong(Department of Gastroenterology,Affiliated Jiangyin Hospital of Nantong University,Wuxi 214400,China)

机构地区：[1]南通大学附属江阴医院消化内科,无锡214400

出　　处：《中华炎性肠病杂志（中英文）》2023年第2期151-156,共6页Chinese Journal of Inflammatory Bowel Diseases

基　　金：无锡市卫生健康委员会青年项目(Q202155);徐州医科大学附属医院科技发展基金项目(XYFC2020002);无锡市卫生健康委转化医学研究专项(ZH202105)。

摘　　要：目的探讨简易指标对诊断克罗恩病(CD)合并肌少症的价值,以便临床早期干预。方法收集南通大学附属江阴医院2018年1月至2022年7月期间住院治疗的105例CD患者的CT图像及相关资料,计算骨骼肌含量指数(SMI)。将患者分为肌少症组与非肌少症组,比较两组间相关临床指标,筛选出简易诊断指标,行ROC曲线分析得出最佳诊断切点。结果纳入105例CD患者,其中合并肌少症66例(62.9%),非肌少症39例(37.1%)。与非肌少症组相比,肌少症组体质指数(BMI)更低[(19.1±2.4)kg/m^(2)比(23.3±3.5)kg/m^(2),P<0.001]、NRS-2002评分更高[3(1,4)分比1(1,2)分,P<0.001]、确诊年龄更小[(31.8±9.8)岁比(36.5±11.9)岁,P=0.017]、更多处于活动期(72.1%比43.6%,P=0.007)。此外,肌少症组前白蛋白[(18.6±7.6)g/L比(21.9±6.3)g/L,P=0.045]、甘油三酯[0.9(0.7,1.2)mmol/L比1.1(0.8,1.6)mmol/L,P=0.012]、肌酐[(68.2±15.1)μmol/L比(79.0±14.9)μmol/L,P=0.001]、肌酐/身高^(2)水平[(23.7±4.3)μmol/(L·m^(2))比(27.5±4.8)μmol/(L·m^(2)),P<0.001]均与非肌少症组存在差异。SMI与BMI、NRS-2002评分、前白蛋白、甘油三酯、肌酐、肌酐/身高^(2)、内脏脂肪指数(VAI)均存在线性相关关系(P均<0.05)。ROC曲线分析提示BMI(AUC=0.854,95%CI:0.778~0.931)和肌酐/身高^(2)(AUC=0.730,95%CI:0.619~0.841)对提示肌少症有良好的价值,最佳截断值分别为20.4及26.6。结论结合BMI、肌酐/身高^(2)来筛查CD患者是否合并肌少症,较为简单易行,便于临床发现肌少症。Objective To explore the value of simple indicators in the diagnosis of Crohn′s disease complicated with sarcopenia for early diagnosis.Methods The CT images and related data of 105 inpatients with Crohn′s disease who were hospitalized from January 2018 to July 2022 in Affiliated Jiangyin Hospital of Nantong University were collected,and the skeletal muscle index(SMI)was calculated.The patients were divided into sarcopenia group and non-sarcopenia group,and the related clinical indicators were compared between the two groups.The ROC curve analysis was used to obtain the best diagnostic cut-off point.Results A total of 105 patients were involoved,including 66(62.9%)with sarcopenia,and 39(37.1%)with non-sarcopenia.Compared with the non-sarcopenia group,the sarcopenia group had lower body mass index(BMI)scores[(19.1±2.4)kg/m^(2) vs.(23.3±3.5)kg/m^(2),P<0.001],higher NRS-2002 scores[3(1,4)vs.1(1,2),P<0.001],younger age at diagnosis[(31.8±9.8)years old vs.(36.5±11.9)years old,P=0.017],higher rates of active stage(72.1%vs.43.6%,P=0.007).The levels of prealbumin[(18.6±7.6)g/L vs.(21.9±6.3)g/L,P=0.045],triglyceride[0.9(0.7,1.2)mmol/L vs.1.1(0.8,1.6)mmol/L,P=0.012],creatinine[(68.2±15.1)μmol/L vs.(79.0±14.9)μmol/L,P=0.001]and creatinine/height^(2)[(23.7±4.3)μmol/(L·m^(2))vs.(27.5±4.8)μmol/(L·m^(2)),P<0.001]in sarcopenia group were different from those in non-sarcopenia group.There was a linear correlation of SMI with BMI,NRS-2002,prealbumin,triglycerides,creatinine,creatinine/height^(2),visceral adipose index(VAI)(P<0.05).ROC curve analysis showed that BMI[AUC=0.854,95%CI(0.778,0.931)]and creatinine/height^(2)[AUC=0.730,95%CI(0.619,0.841)]had good value in suggesting sarcopenia,and the optimal cut-off values were 20.4 and 26.6,respectively.Conclusion Combining BMI,creatinine/height^(2) to screen Crohn′s patients for sarcopenia is relatively simple and easy to perform,and facilitates clinical detection of sarcopenia.

关 键 词：克罗恩病 肌少症 人体成分 血清肌酐 

分 类 号：R574[医药卫生—消化系统] R685[医药卫生—内科学]