Lodewick Toine M, Roeth Anjali A J, Olde Damink Steven W M, Alizai Patrick H, van Dam Ronald M, Gassler Nikolaus, Schneider Mark, Dello Simon A W G, Schmeding Maximilian, Dejong Cornelis H C, Neumann Ulf P
Department of Surgery, Division of General, Visceral and Transplantation Surgery, RWTH Aachen University, Aachen, Germany.
Department of Surgery, Maastricht University Medical Centre & Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
J Cachexia Sarcopenia Muscle. 2015 Jun;6(2):155-63. doi: 10.1002/jcsm.12018. Epub 2015 Apr 28.
Sarcopenia, obesity and sarcopenic obesity have been linked to impaired outcome after liver surgery. Preoperative liver function of sarcopenic, obese and sarcopenic-obese patients might be reduced, possibly leading to more post-operative morbidity. The aim of this study was to explore whether liver function and volume were influenced by body composition in patients undergoing liver resection.
In 2011 and 2012, all consecutive patients undergoing the methacetin breath liver function test were included. Liver volumetry and muscle mass analysis were performed using preoperative CT scans and Osirix(®) software. Muscle mass and body-fat% were calculated. Predefined cut-off values for sarcopenia and the top two body-fat% quintiles were used to identify sarcopenia and obesity, respectively. Histologic assessment of the resected liver gave insight in background liver disease.
A total number of 80 patients were included. Liver function and volume were comparable in sarcopenic(-obese) and non-sarcopenic(-obese) patients. Obese patients showed significantly reduced liver function [295 (95-508) vs. 358 (96-684) µg/kg/h, P = 0.018] and a trend towards larger liver size [1694 (1116-2685) vs. 1533 (869-2852) mL, P = 0.079] compared with non-obese patients. Weight (r = -0.40), body surface area (r = -0.32), estimated body-fat% (r = -0.43) and body mass index (r = -0.47) showed a weak but significant negative (all P < 0.05) correlation with liver function. Moreover, body-fat% was identified as an independent factor negatively affecting the liver function.
Sarcopenia and sarcopenic obesity did not seem to influence liver size and function negatively. However, obese patients had larger, although less functional, livers, indicating dissociation of liver function and volume in these patients.
肌肉减少症、肥胖症和肌少症肥胖与肝切除术后预后不良有关。肌肉减少症患者、肥胖症患者和肌少症肥胖患者的术前肝功能可能会降低，这可能会导致更多的术后并发症。本研究的目的是探讨肝切除患者的肝功能和肝脏体积是否受身体组成的影响。
纳入2011年和2012年所有连续接受美沙西汀呼吸肝功能试验的患者。使用术前CT扫描和Osirix（®）软件进行肝脏容积测定和肌肉质量分析。计算肌肉质量和体脂百分比。分别使用肌肉减少症的预定义临界值和体脂百分比最高的两个五分位数来识别肌肉减少症和肥胖症。对切除肝脏的组织学评估有助于了解背景性肝病。
共纳入80例患者。肌肉减少症（肥胖症）患者和非肌肉减少症（肥胖症）患者的肝功能和肝脏体积相当。与非肥胖患者相比，肥胖患者的肝功能显著降低[295（95 - 508）对358（96 - 684）μg/kg/h，P = 0.018]，且肝脏大小有增大趋势[1694（1116 - 2685）对1533（869 - 2852）mL，P = 0.079]。体重（r = -0.40）、体表面积（r = -0.32）、估计体脂百分比（r = -0.43）和体重指数（r = -0.47）与肝功能呈弱但显著的负相关（所有P < 0.05）。此外，体脂百分比被确定为对肝功能有负面影响的独立因素。
肌肉减少症和肌少症肥胖似乎不会对肝脏大小和功能产生负面影响。然而，肥胖患者的肝脏更大，但功能较差，这表明这些患者的肝功能和肝脏体积存在分离。
