基于定量CT对骨髓外不同部位脂肪分布预测克罗恩病疾病活动度的研究

Relationship between changes of D-dimer levels during pregnancy and risk for postpartum pulmonary embolism

关键词:  克罗恩病  定量CT  骨髓外脂肪  疾病活动度

Key words:  Crohn’s disease  quantitative CT  extramedullary fat  disease activity

摘要:

目的 探讨预测克罗恩病（Crohn’s disease, CD）疾病活动度的骨髓外脂肪影像学标志物。方法 使用定量CT（quantitative computed tomography, QCT）测定104例CD患者的肝脾密度比值（liver-to-spleen attenuation ratio, LSR）、总腰腹肌内脂肪面积（total lumboabdominal intramuscular fat area, TLIFA）、内脏脂肪面积（visceral fat area, VFA）、皮下脂肪面积（subcutaneous fat area, SFA）以及VFA与SFA的比值(visceral to subcutaneous adipose tissue area ratios, VSR)。依据CD活动指数（Crohn’s disease activity index, CDAI）将患者分为缓解期组（CDAI＜150, n=45）和活动期组（CDAI≥150, n=59）。采用独立样本t检验或Mann-Whitney U检验比较两组间各脂肪参数的差异，Pearson或Spearman检验分析各脂肪参数和CDAI的相关性，单因素和多因素Logistic回归分析检验CDAI与各脂肪参数之间的关系，受试者工作特征曲线分析各脂肪参数预测活动期CD的效能。结果 两组的LSR差异无统计学意义，活动期组的体重指数（body mass index, BMI）、VFA、SFA以及TLIFA均低于缓解期组（P分别为0.04、0.038、＜0.001、0.02），活动期组的VSR高于缓解期组（P=0.01）。校正性别、年龄及BMI后，仅VSR与CDAI呈正相关（r=0.336，P=0.001），仅TLIFA与CDAI呈负相关（r=-0.217，P=0.029）。单因素Logistic回归分析显示SFA、VSR以及TLIFA是CDAI的影响因子，多因素Logistic回归分析显示仅VSR是CDAI的独立影响因子（OR=2.548，P=0.038）。SFA预测活动期CD的效能（AUC=0.727）略高于VSR（AUC=0.686）和TLIFA（AUC=0.681），联合上述三个参数时诊断效能最高（AUC=0.750）。结论 SFA、VSR以及TLIFA是CD患者疾病活动度的影响因子，三者联合是预测活动期CD最佳的骨髓外脂肪影像学标志物。

Abstract:

Objective To explore the relationship between the change of D-dimer during pregnancy and the occurrence of postpartum pulmonary embolism. Methods The clinical data of 279 pregnant women who were registered for antenatal check-up and delivery in Obstetrics and Gynecology Hospital of Tongji University from January 2018 to January 2023 were analyzed retrospectively. Plasma D-dimer levels were dynamically detected and documented. Postpartum pulmonary embolism occurred in 104 cases(case group), pregnant women without pulmonary embolism served as control group(n=168). The relationship between the changes of D-dimer levels during pregnancy and the occurrence of postpartum pulmonary embolism was analyzed. Results There was no significant difference in conception mode, maternal height, weight and BMI, and the number of fetal arrest between the case group and the control group(P>0.05). There were significant differences in age, number of births, gravidity and parity(P<0.05) between two groups. There was higher proportion of pregnant women with older age, multiple births and multiple births in the case group. The plasma D-dimer levels were elevated with the increase of gestational age in the case group. The postpartum D-dimer levels in the case group were significantly higher than those in the control group(Z=-4.520, P<0.05); while there were no significant differences in D-dimer levels at time of registration and pre-delivery period(Z=-0.669, P=0.504; Z=-0.804, P=0.421) between two groups). The higher postpartum D-dimer levels(6.325-18.25 mg/L) were associated with the risk of pulmonary embolism. Conclusion The levels of plasma D-dimer during pregnancy and childbirth show an increasing trend. The changes of plasma D-dimer during postpartum period may increase the risk of the occurrence of postpartum pulmonary embolism.