炎症性腸疾患とサルコペニア・悪液質

炎症性腸疾患とサルコペニア・悪液質に関する記述研究を紹介します。

Igor Khoroshilov, Sergius IvanovAims: Prevalence of undernutrition, sarcopenia and cachexia in patients with inflammatory bowel diseases

炎症性腸疾患は慢性炎症をおこす疾患ですので、当然、悪液質の原因疾患の1つとなります。今回は潰瘍性大腸炎とクローン病で、低栄養、悪液質、サルコペニアに該当する方がどのくらいいつかを調査しています。サルコペニアは上肢の筋肉量で評価しています。

低栄養、悪液質、サルコペニアに該当したのは、潰瘍性大腸炎でそれぞれ42％、25％、10％、クローン病でそれぞれ54％、27％、8％でした。血清総蛋白、アルブミン、総リンパ球数の低下も一部の患者で認めています。

サルコペニアの診断基準に改善の余地があると思いますが、炎症性腸疾患患者の4人に1人はサルコペニアといえます。また、悪液質を認める患者はサルコペニアの半数以下ですので、サルコペニアの原因として最も重要なのは、悪液質よりも飢餓・吸収障害かもしれません。ただ、悪液質への配慮も必要です。

Aim: This paper aims to study the prevalence of undernutrition, sarcopenia, and cachexia in patients with inflammatory bowel diseases in acute phase.

Methods: Thirty patients with ulcerative colitis and 26 patients with Crohn’s disease in acute phase had been inspected in hospital conditions. We studied the body weight, body mass index, body composition, muscle volume of arm, protein content in the blood, and number of lymphocytes in the blood. Content of fat body mass and fat-free mass was determined by methods of bioelectrical impedance and dual energy X-ray absorbtiometry.

Results: Reduction of the body weight and body mass index (<18.5) was detected in 42% of patients with ulcerative colitis and 54% of patients with Crohn’s disease. The diagnosis “cachexia” was installed in 10% of patients with ulcerative colitis and 8% of patients with Crohn’s disease. Reduction of the muscle volume of arm (sarcopenia) has been revealed in 25% of patients with ulcerative colitis and 27% of patients with Crohn’s disease. Hypoproteinemia and hypoalbuminemia took place in 16% of patients in both groups, reducing of number of lymphocytes in the blood in 14% of patients with ulcerative colitis and 27% of patients with Crohn’s disease.

Conclusions: Undernutrition was detected in 42–54% of patients with inflammatory bowel diseases, however diagnosis of cachexia was installed in 8–10% of patients, sarcopenia took place in 25–27% of patients with inflammatory bowel diseases in acute phase.