Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Nutrition. 2018 Jan;45:1-10. doi: 10.1016/j.nut.2017.06.027. Epub 2017 Jul 13.
This study investigated the effect of preoperative sarcopenia on cardiopulmonary function in patients undergoing living donor liver transplantation (LDLT).
A retrospective analysis was performed of 207 patients who underwent LDLT between January 2008 and April 2015. The quantity and quality of skeletal muscle were evaluated by the psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), respectively, using preoperative computed tomography imaging. The correlations between preoperative cardiopulmonary function and sarcopenic factors (PMI, IMAC, and grip strength [GS]) were examined. Moreover, overall survival (OS) rates according to preoperative pulmonary function and risk factors were analyzed.
No significant differences were found between ejection fraction (EF) and these sarcopenic factors. In contrast, preoperative vital capacity (VC) and forced expiratory volume (FEV) 1.0 were significantly correlated with PMI (P < 0.001, P < 0.001), IMAC (P = 0.024, P = 0.013), and GS (P = 0.006, P = 0.033) in males. Preoperative VC and FEV1.0 were significantly correlated with IMAC (P = 0.002, P = 0.001) and GS (P = 0.002, P = 0.001) in females. Moreover, %VC, VC, and FEV1.0 in the preoperative low muscle mass group were significantly lower than in the normal muscle mass group (P = 0.004, P < 0.001, P < 0.001, respectively) in males. Multivariate analysis revealed that preoperative low PMI and preoperative restrictive ventilatory impairment were independent risk factors (P = 0.046 and P = 0.014, respectively).
Preoperative low muscle mass was closely involved with pulmonary dysfunction in patients undergoing LDLT.
本研究旨在探讨术前骨骼肌减少症对活体肝移植（LDLT）患者心肺功能的影响。
回顾性分析了 207 例 2008 年 1 月至 2015 年 4 月期间接受 LDLT 的患者。使用术前 CT 成像评估骨骼肌的数量和质量，分别用腰大肌质量指数（PMI）和肌内脂肪组织含量（IMAC）表示。检查术前心肺功能与肌减少症相关因素（PMI、IMAC 和握力[GS]）之间的相关性。此外，还根据术前肺功能和危险因素分析了总生存率（OS）。
射血分数（EF）与这些肌减少症因素之间无显著差异。相比之下，男性患者的术前肺活量（VC）和用力呼气量（FEV1.0）与 PMI（P<0.001，P<0.001）、IMAC（P=0.024，P=0.013）和 GS（P=0.006，P=0.033）显著相关。女性患者的术前 VC 和 FEV1.0 与 IMAC（P=0.002，P=0.001）和 GS（P=0.002，P=0.001）显著相关。此外，男性患者低肌肉质量组的%VC、VC 和 FEV1.0 显著低于正常肌肉质量组（P=0.004，P<0.001，P<0.001）。多变量分析显示，术前低 PMI 和术前限制性通气障碍是独立的危险因素（P=0.046 和 P=0.014）。
术前低肌肉量与 LDLT 患者的肺功能障碍密切相关。
