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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">perinatology</journal-id><journal-title-group><journal-title xml:lang="ru">Российский вестник перинатологии и педиатрии</journal-title><trans-title-group xml:lang="en"><trans-title>Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1027-4065</issn><issn pub-type="epub">2500-2228</issn><publisher><publisher-name>Ltd. “The National Academy of Pediatric Science and Innovation”</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21508/1027-4065-2025-70-6-44-52</article-id><article-id custom-type="elpub" pub-id-type="custom">perinatology-2312</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>Саркопения, патология печени и билиарного тракта у детей с воспалительными заболеваниями кишечника</article-title><trans-title-group xml:lang="en"><trans-title>Sarcopenia and hepatobiliary disorders in children with inflammatory bowel disease</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1835-5649</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гайфутдинова</surname><given-names>А. Р.</given-names></name><name name-style="western" xml:lang="en"><surname>Gaifutdinova</surname><given-names>A. R.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гайфутдинова Алия Ринатовна — аспирант кафедры госпитальной педиатрии</p><p>420012, г. Казань, ул. Бутлерова, 49</p></bio><bio xml:lang="en"><p>420012, Kazan </p></bio><email xlink:type="simple">gaifutdinova.alia@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3707-6511</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Валеева</surname><given-names>И. Х.</given-names></name><name name-style="western" xml:lang="en"><surname>Valeeva</surname><given-names>I. Kh.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Валеева Илдария Хайрулловна — д.б.н., с.н.с. Центральной научно-исследовательской лаборатории</p><p>420012, г. Казань, ул. Бутлерова, 49</p></bio><bio xml:lang="en"><p>420012, Kazan </p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3261-9986</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Малов</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Malov</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Малов Алексей Анатольевич — ассистент кафедры онкологии с курсом лучевой диагностики и лучевой терапии ; врач-рентгенолог отделения лучевой диагностики</p><p>420012, г. Казань, ул. Бутлерова, 49</p></bio><bio xml:lang="en"><p>420012, Kazan </p><p>420138, Kazan </p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0009-0814-0773</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ханафина</surname><given-names>М. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Khanafina</surname><given-names>M. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ханафина Марина Алексеевна — аспирант кафедры госпитальной педиатрии</p><p>420012, г. Казань, ул. Бутлерова, 49</p></bio><bio xml:lang="en"><p>420012, Kazan </p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2957-680X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Камалова</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kamalova</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Камалова Аэлита Асхатовна — д.м.н, проф. кафедры госпитальной педиатрии; врач диагностического отделения</p><p>420012, г. Казань, ул. Бутлерова, 49 </p></bio><bio xml:lang="en"><p>420012, Kazan </p><p>420138, Kazan </p></bio><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kazan State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава России ; ГАУЗ «Детская республиканская клиническая больница»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kazan State Medical University ; Republican Children’s Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>30</day><month>12</month><year>2025</year></pub-date><volume>70</volume><issue>6</issue><fpage>44</fpage><lpage>52</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Ltd. “The National Academy of Pediatric Science and Innovation”, 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Ltd. “The National Academy of Pediatric Science and Innovation”</copyright-holder><copyright-holder xml:lang="en">Ltd. “The National Academy of Pediatric Science and Innovation”</copyright-holder><license xlink:href="https://www.ped-perinatology.ru/jour/about/submissions#copyrightNotice" xlink:type="simple"><license-p>https://www.ped-perinatology.ru/jour/about/submissions#copyrightNotice</license-p></license></permissions><self-uri xlink:href="https://www.ped-perinatology.ru/jour/article/view/2312">https://www.ped-perinatology.ru/jour/article/view/2312</self-uri><abstract><p>Саркопения, характеризующаяся снижением мышечной массы и ее функциональной активности, является актуальной, но недостаточно изученной проблемой у детей с воспалительными заболеваниями кишечника. Снижение мышечной массы может неблагоприятно влиять на течение воспалительных заболеваний кишечника, повышать частоту осложнений и снижать эффективность терапии. В последнее время появляются данные о взаимосвязи саркопении и гепатобилиарной патологии у пациентов с воспалительными заболеваниями кишечника. Однако в связи с ограниченным числом исследований и отсутствием единых критериев диагностики частота саркопении у детей с воспалительными заболеваниями кишечника и сопутствующей гепатобилиарной патологией остается неустановленной.Цель исследования — оценить частоту саркопении у детей с воспалительными заболеваниями кишечника и определить взаимосвязи между снижением мышечной массы и маркерами поражения печени.Материалы и методы. Обследованы 36 детей с воспалительными заболеваниями кишечника: 18 с язвенным колитом и 18 с болезнью Крона. Оценены лабораторные показатели состояния гепатобилиарной системы, проведена биоимпедансометрия и оценка площади поясничных мышц (tPMA) по данным компьютерной и магнитно-резонансной томографии.Результаты. Признаки саркопении по tPMA выявлены у 61% пациентов. Снижение скелетно-мышечной массы по данным биоимпедансометрии отмечалось у 19,4% детей, чаще при наличии гепатобилиарной патологии. Между tPMA и параметрами состава тела установлена высокая степень корреляции.Выводы. Полученные результаты подчеркивают важность комплексной оценки нутритивного статуса у детей с воспалительными заболеваниями кишечника, особенно при сочетании с гепатобилиарной патологией. Необходимы дальнейшие проспективные исследования саркопении в данной группе пациентов.</p></abstract><trans-abstract xml:lang="en"><p>Sarcopenia, characterized as a reduction of skeletal muscle mass and functional capacity, remains a relevant but insufficiently studied issue in pediatric patients with inflammatory bowel disease. Loss of muscle mass may negatively affect the course of inflammatory bowel disease, increase the frequency of complications, and reduce treatment effectiveness. Recent studies have highlighted a possible association between sarcopenia and hepatobiliary manifestations in patients with inflammatory bowel disease. However, due to the limited number of studies and the absence of diagnostic guidelines, the prevalence of sarcopenia in children with inflammatory bowel disease and concomitant hepatobiliary manifestations remains unclear.Objective. To assess the prevalence of sarcopenia in children with inflammatory bowel disease and to determine associations between reduced muscle mass and laboratory markers of liver injury.Materials and Methods. Thirty-six children with inflammatory bowel disease were examined, including 18 with ulcerative colitis and 18 with Crohn’s disease. Laboratory markers were analyzed. Body composition was assessed using bioelectrical impedance analysis, and total psoas muscle area (tPMA) was measured via computed tomography or magnetic resonance imaging.Results: Sarcopenia based on tPMA (z-score &lt; –2) was found in 61% of patients. A decrease of skeletal muscle mass measured by bioimpedance analysis was observed in 19.4% of children, more frequently in those with hepatobiliary manifestations. A strong correlation between tPMA and body composition parameters was found.Conclusion: These findings emphasize the importance of comprehensive nutritional assessment in children with inflammatory bowel disease, especially in the presence of hepatobiliary manifestations. Further prospective studies on sarcopenia in these patients are needed.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>дети</kwd><kwd>воспалительные заболевания кишечника</kwd><kwd>саркопения</kwd><kwd>печень</kwd><kwd>биоимпедансометрия</kwd><kwd>m. psoas</kwd></kwd-group><kwd-group xml:lang="en"><kwd>inflammatory bowel disease</kwd><kwd>children</kwd><kwd>sarcopenia</kwd><kwd>liver</kwd><kwd>bioimpedance analysis</kwd><kwd>m. psoas</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Lurz E., Patel H., Frimpong R., Ricciuto A., Kehar M., Wales P.W. et al. Sarcopenia in children with endstage liver disease. Journal of Pediatric Gastroenterology and Nutrition. 2018; 66(2): 222–226. DOI: 10.1097/MPG.0000000000001792</mixed-citation><mixed-citation xml:lang="en">Lurz E., Patel H., Frimpong R., Ricciuto A., Kehar M., Wales P.W. et al. Sarcopenia in children with endstage liver disease. Journal of Pediatric Gastroenterology and Nutrition. 2018; 66(2): 222–226. DOI: 10.1097/MPG.0000000000001792</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Mager D.R., Hager A., Ooi P.H., Siminoski K., Gilmour S.M., Yap J.K. Persistence of sarcopenia after pediatric liver transplantation is associated with poorer growth and recurrent hospital admissions. Journal of Parenteral and Enteral Nutrition. 2019; 43(2): 271–280. DOI: 10.1002/jpen.1414</mixed-citation><mixed-citation xml:lang="en">Mager D.R., Hager A., Ooi P.H., Siminoski K., Gilmour S.M., Yap J.K. Persistence of sarcopenia after pediatric liver transplantation is associated with poorer growth and recurrent hospital admissions. Journal of Parenteral and Enteral Nutrition. 2019; 43(2): 271–280. DOI: 10.1002/jpen.1414</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Steell L., Gray S.R., Russell R.K., MacDonald J., Seenan J.P., Wong C.W. et al. Pathogenesis of musculoskeletal deficits in children and adults with inflammatory bowel disease. Nutrients. 2021; 13(8): 2899. DOI: 10.3390/nu13082899</mixed-citation><mixed-citation xml:lang="en">Steell L., Gray S.R., Russell R.K., MacDonald J., Seenan J.P., Wong C.W. et al. Pathogenesis of musculoskeletal deficits in children and adults with inflammatory bowel disease. Nutrients. 2021; 13(8): 2899. DOI: 10.3390/nu13082899</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Fatani H., Olaru A., Stevenson R., Alharazi W., Jafer A., Atherton P. et al. Systematic review of sarcopenia in inflammatory bowel disease. Clinical Nutrition. 2023; 42(8): 1016–1025. DOI: 10.1016/j.clnu.2023.05.002</mixed-citation><mixed-citation xml:lang="en">Fatani H., Olaru A., Stevenson R., Alharazi W., Jafer A., Atherton P. et al. Systematic review of sarcopenia in inflammatory bowel disease. Clinical Nutrition. 2023; 42(8): 1016–1025. DOI: 10.1016/j.clnu.2023.05.002</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">Atlan L., Cohen S., Shiran S., Sira L.B., Pratt L., YerushalmyFeler A. Sarcopenia is a predictor for adverse clinical outcome in pediatric inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition. 2021; 72(6): 883–888. DOI: 10.1097/MPG.0000000000003091</mixed-citation><mixed-citation xml:lang="en">Atlan L., Cohen S., Shiran S., Sira L.B., Pratt L., YerushalmyFeler A. Sarcopenia is a predictor for adverse clinical outcome in pediatric inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition. 2021; 72(6): 883–888. DOI: 10.1097/MPG.0000000000003091</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Navarro P., Gutierrez-Ramirez L., Tejera-Munoz A., Arias A., Lucendo A.J. Systematic review and meta-analysis: prevalence of non-alcoholic fatty liver disease and liver fibrosis in patients with inflammatory bowel disease. Nutrients. 2023; 15(21): 4507. DOI: 10.3390/nu15214507</mixed-citation><mixed-citation xml:lang="en">Navarro P., Gutierrez-Ramirez L., Tejera-Munoz A., Arias A., Lucendo A.J. Systematic review and meta-analysis: prevalence of non-alcoholic fatty liver disease and liver fibrosis in patients with inflammatory bowel disease. Nutrients. 2023; 15(21): 4507. DOI: 10.3390/nu15214507</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">Lin A., Roth H., Anyane-Yeboa A., Rubin D.T., Paul S. Prevalence of nonalcoholic fatty liver disease in patients with inflammatory bowel disease: a systematic review and meta-analysis. Inflammatory Bowel Diseases. 2021; 27(6): 947– 955. DOI: 10.1093/ibd/izaa189</mixed-citation><mixed-citation xml:lang="en">Lin A., Roth H., Anyane-Yeboa A., Rubin D.T., Paul S. Prevalence of nonalcoholic fatty liver disease in patients with inflammatory bowel disease: a systematic review and meta-analysis. Inflammatory Bowel Diseases. 2021; 27(6): 947– 955. DOI: 10.1093/ibd/izaa189</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Karaivazoglou K., Konstantakis Ch., Tourkochristou E., Assimakopoulos S., Triantos Ch. Non-alcoholic fatty liver disease in inflammatory bowel disease patients. European Journal of Gastroenterology &amp; Hepatology. 2020; 32(8): 903–906. DOI: 10.1097/MEG.0000000000001679</mixed-citation><mixed-citation xml:lang="en">Karaivazoglou K., Konstantakis Ch., Tourkochristou E., Assimakopoulos S., Triantos Ch. Non-alcoholic fatty liver disease in inflammatory bowel disease patients. European Journal of Gastroenterology &amp; Hepatology. 2020; 32(8): 903–906. DOI: 10.1097/MEG.0000000000001679</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">Kang M.K., Kim K.O., Kim M.C., Park J.G., Jang B.I. Sarcopenia is a new risk factor of nonalcoholic fatty liver disease in patients with inflammatory bowel disease. Digestive Diseases. 2020; 38(6): 507–514. DOI: 10.1159/000506938</mixed-citation><mixed-citation xml:lang="en">Kang M.K., Kim K.O., Kim M.C., Park J.G., Jang B.I. Sarcopenia is a new risk factor of nonalcoholic fatty liver disease in patients with inflammatory bowel disease. Digestive Diseases. 2020; 38(6): 507–514. DOI: 10.1159/000506938</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Deng C., Ou Q., Ou X., Pan D. Association between non-alcoholic fatty liver disease and risk of sarcopenia: a systematic review and meta-analysis. BMJ Open. 2024; 14(5): e078933. DOI: 10.1136/bmjopen-2023-078933</mixed-citation><mixed-citation xml:lang="en">Deng C., Ou Q., Ou X., Pan D. Association between non-alcoholic fatty liver disease and risk of sarcopenia: a systematic review and meta-analysis. BMJ Open. 2024; 14(5): e078933. DOI: 10.1136/bmjopen-2023-078933</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Nishikawa H., Nakamura Sh., Miyazaki T., Kakimoto K., Fukunishi Sh, Asai A. et al. Inflammatory bowel disease and sarcopenia: its mechanism and clinical importance. Journal of Clinical Medicine. 2021; 10(18): 4214. DOI: 10.3390/jcm10184214</mixed-citation><mixed-citation xml:lang="en">Nishikawa H., Nakamura Sh., Miyazaki T., Kakimoto K., Fukunishi Sh, Asai A. et al. Inflammatory bowel disease and sarcopenia: its mechanism and clinical importance. Journal of Clinical Medicine. 2021; 10(18): 4214. DOI: 10.3390/jcm10184214</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">Aljilani B., Tsintzas K., Jacques M., Radford S., Moran G.W. Systematic review: Sarcopenia in paediatric inflammatory bowel disease. Clinical Nutrition ESPEN. 2023; 57: 647–654. DOI: 10.1016/j.clnesp.2023.08.009</mixed-citation><mixed-citation xml:lang="en">Aljilani B., Tsintzas K., Jacques M., Radford S., Moran G.W. Systematic review: Sarcopenia in paediatric inflammatory bowel disease. Clinical Nutrition ESPEN. 2023; 57: 647–654. DOI: 10.1016/j.clnesp.2023.08.009</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">Daichendt L., Kalia V., Ali A., Sawicka J., Miller M., Wells S. et al. P0312 Sarcopenia as a feature of musculoskeletal manifestations of paediatric Crohn’s disease. Journal of Crohn’s and Colitis. 2025; 19(Suppl 1): i769. DOI: 10.1093/ecco-jcc/jjae190.0486</mixed-citation><mixed-citation xml:lang="en">Daichendt L., Kalia V., Ali A., Sawicka J., Miller M., Wells S. et al. P0312 Sarcopenia as a feature of musculoskeletal manifestations of paediatric Crohn’s disease. Journal of Crohn’s and Colitis. 2025; 19(Suppl 1): i769. DOI: 10.1093/ecco-jcc/jjae190.0486</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Dahlwi G., Yodoshi T., Church P., Ricciuto A. A230 Sarcopenia in primary sclerosing cholangitis and inflammatory bowel disease in paediatrics and clinical implications. Journal of the Canadian Association of Gastroenterology. 2024; 7(Suppl 1): 183–184. DOI: 10.1093/jcag/gwad061.230</mixed-citation><mixed-citation xml:lang="en">Dahlwi G., Yodoshi T., Church P., Ricciuto A. A230 Sarcopenia in primary sclerosing cholangitis and inflammatory bowel disease in paediatrics and clinical implications. Journal of the Canadian Association of Gastroenterology. 2024; 7(Suppl 1): 183–184. DOI: 10.1093/jcag/gwad061.230</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Bezzio C., Brinch D., Ribaldone D.G., Cappello M., Ruzzon N., Vernero M. et al. Prevalence, risk factors and association with clinical outcomes of malnutrition and sarcopenia in inflammatory bowel disease: a prospective study. Nutrients. 2024; 16(23): 3983. DOI: 10.3390/nu16233983</mixed-citation><mixed-citation xml:lang="en">Bezzio C., Brinch D., Ribaldone D.G., Cappello M., Ruzzon N., Vernero M. et al. Prevalence, risk factors and association with clinical outcomes of malnutrition and sarcopenia in inflammatory bowel disease: a prospective study. Nutrients. 2024; 16(23): 3983. DOI: 10.3390/nu16233983</mixed-citation></citation-alternatives></ref><ref id="cit16"><label>16</label><citation-alternatives><mixed-citation xml:lang="ru">Lurz E., Patel H., Lebovic G., Quammie C., Woolfson J.P., Perez M. et al. Paediatric reference values for total psoas muscle area. Journal of Cachexia, Sarcopenia and Muscle. 2020; 11(2): 405–414. DOI: 10.1002/jcsm.12514</mixed-citation><mixed-citation xml:lang="en">Lurz E., Patel H., Lebovic G., Quammie C., Woolfson J.P., Perez M. et al. Paediatric reference values for total psoas muscle area. Journal of Cachexia, Sarcopenia and Muscle. 2020; 11(2): 405–414. DOI: 10.1002/jcsm.12514</mixed-citation></citation-alternatives></ref><ref id="cit17"><label>17</label><citation-alternatives><mixed-citation xml:lang="ru">Merli M. Pediatric sarcopenia: exploring a new concept in children with chronic liver disease. Jornal de Pediatria. 2020; 96(4): 406–408. DOI: 10.1016/j.jped.2019.08.001</mixed-citation><mixed-citation xml:lang="en">Merli M. Pediatric sarcopenia: exploring a new concept in children with chronic liver disease. Jornal de Pediatria. 2020; 96(4): 406–408. DOI: 10.1016/j.jped.2019.08.001</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
