Zhang Tenghui, Cao Lei, Cao Tingzhi, Yang Jianbo, Gong Jianfeng, Zhu Weiming, Li Ning, Li Jieshou
1 Department of General Surgery, Jinling Hospital Affiliated to Southern Medical University, Nanjing, China.
2 Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
JPEN J Parenter Enteral Nutr. 2017 May;41(4):592-600. doi: 10.1177/0148607115612054. Epub 2015 Oct 15.
Sarcopenia has been proposed to be a prognostic factor of outcomes for various diseases but has not been applied to Crohn's disease (CD). We aimed to assess the impact of sarcopenia on postoperative outcomes after bowel resection in patients with CD.
Abdominal computed tomography images within 30 days before bowel resection in 114 patients with CD between May 2011 and March 2014 were assessed for sarcopenia as well as visceral fat areas and subcutaneous fat areas. The impact of sarcopenia on postoperative outcomes was evaluated using univariate and multivariate analyses.
Of 114 patients, 70 (61.4%) had sarcopenia. Patients with sarcopenia had a lower body mass index, lower preoperative levels of serum albumin, and more major complications (15.7% vs 2.3%, P = .027) compared with patients without sarcopenia. Moreover, predictors of major postoperative complications were sarcopenia (odds ratio [OR], 9.24; P = .04) and a decreased skeletal muscle index (1.11; P = .023). Preoperative enteral nutrition (OR, 0.13; P = .004) and preoperative serum albumin level >35 g/L (0.19; P = .017) were protective factors in multivariate analyses.
The prevalence of sarcopenia is high in patients with CD requiring bowel resection. It significantly increases the risk of major postoperative complications and has clinical implications with respect to nutrition management before surgery for CD.
肌肉减少症已被认为是多种疾病预后的一个因素，但尚未应用于克罗恩病（CD）。我们旨在评估肌肉减少症对CD患者肠切除术后结局的影响。
对2011年5月至2014年3月期间114例CD患者在肠切除术前30天内的腹部计算机断层扫描图像进行评估，以确定是否存在肌肉减少症以及内脏脂肪面积和皮下脂肪面积。使用单因素和多因素分析评估肌肉减少症对术后结局的影响。
114例患者中，70例（61.4%）存在肌肉减少症。与无肌肉减少症的患者相比，有肌肉减少症的患者体重指数较低，术前血清白蛋白水平较低，且主要并发症更多（15.7%对2.3%，P = 0.027）。此外，术后主要并发症的预测因素是肌肉减少症（比值比[OR]，9.24；P = 0.04）和骨骼肌指数降低（1.11；P = 0.023）。在多因素分析中，术前肠内营养（OR，0.13；P = 0.004）和术前血清白蛋白水平>35 g/L（0.19；P = 0.017）是保护因素。
需要进行肠切除的CD患者中肌肉减少症的患病率很高。它显著增加了术后主要并发症的风险，并且对CD患者术前的营养管理具有临床意义。
