肥胖是否会影响溃疡性结肠炎患者艰难梭菌感染的风险？
Does Obesity Influence the Risk of Clostridium difficile Infection Among Patients with Ulcerative Colitis?
机构信息
Division of Gastroenterology, Scripps Clinic, 10666 N. Torrey Pines Rd, La Jolla, CA, 92037, USA.
Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
出版信息
Dig Dis Sci. 2018 Sep;63(9):2445-2450. doi: 10.1007/s10620-018-5108-2. Epub 2018 May 19.
BACKGROUND
Patients with ulcerative colitis (UC) are at an increased risk of Clostridium difficile infection (CDI) compared with the general population. Recent data suggest that obesity also increases the risk of CDI.
AIMS
To examine whether obesity influences the risk of CDI among patients with UC.
STUDY
We conducted a retrospective cross-sectional study of UC patients seen in gastroenterology clinic between January 1, 2014, and December 31, 2015. Records were reviewed for patients with the diagnosis of UC prior to 2014, and the first diagnosis of CDI between January 1, 2014, and December 31, 2015. Using body mass index (BMI), patients were classified into underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). Age-adjusted and multivariate logistic regression was performed including gender, tobacco use, UC disease duration, medication exposure, and vitamin D deficiency.
RESULTS
Of the 636 patients with UC, 114 (18%) were obese, 232 (36%) overweight, 274 (43%) normal weight, and 16 (2.5%) underweight. Nineteen patients (3.0%) developed CDI during the study period. CDI risk was not associated with BMI (OR 0.90, 95% CI 0.79-1.02). Compared to normal weight patients, risk of CDI was not influenced by being obese (multivariate OR 0.63, 95% CI 0.15-2.58), overweight (multivariate OR 0.33, 95% CI 0.08-1.30), or underweight (multivariate OR 2.98, 95% CI 0.45-19.83). CDI was associated with ever use of TNF therapy (multivariate OR 6.09, 95% CI 2.07-17.93) but not vedolizumab (multivariate OR 0.76, 95% CI 0.08-7.36).
CONCLUSIONS
Obesity does not appear to be associated with the risk of C. difficile infection among patients with UC.
背景
与普通人群相比，溃疡性结肠炎（UC）患者发生艰难梭菌感染（CDI）的风险增加。最近的数据表明，肥胖也会增加 CDI 的风险。
目的
研究肥胖是否会影响 UC 患者发生 CDI 的风险。
研究
我们对 2014 年 1 月 1 日至 2015 年 12 月 31 日期间在胃肠病学诊所就诊的 UC 患者进行了回顾性横断面研究。对 2014 年前诊断为 UC 的患者的记录进行了回顾，并对 2014 年 1 月 1 日至 2015 年 12 月 31 日期间首次诊断为 CDI 的患者进行了记录。使用体重指数（BMI）将患者分为消瘦（BMI＜18.5）、正常体重（18.5≤BMI＜25）、超重（25≤BMI＜30）和肥胖（BMI≥30）。进行了年龄调整和多变量逻辑回归，包括性别、吸烟、UC 疾病持续时间、药物暴露和维生素 D 缺乏。
结果
在 636 名 UC 患者中，有 114 名（18%）肥胖，232 名（36%）超重，274 名（43%）正常体重，16 名（2.5%）消瘦。在研究期间，有 19 名患者（3.0%）发生 CDI。CDI 风险与 BMI 无关（OR 0.90，95%CI 0.79-1.02）。与正常体重患者相比，肥胖（多变量 OR 0.63，95%CI 0.15-2.58）、超重（多变量 OR 0.33，95%CI 0.08-1.30）或消瘦（多变量 OR 2.98，95%CI 0.45-19.83）患者的 CDI 风险均无显著差异。CDI 与 TNF 治疗的使用有关（多变量 OR 6.09，95%CI 2.07-17.93），但与 vedolizumab 无关（多变量 OR 0.76，95%CI 0.08-7.36）。
结论
肥胖似乎与 UC 患者发生艰难梭菌感染的风险无关。
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