Department of Surgery, James Connolly Hospital, Dublin, Ireland.
Inflamm Bowel Dis. 2019 Jan 1;25(1):67-73. doi: 10.1093/ibd/izy212.
Sarcopenia is associated with increased morbidity and mortality in oncologic and transplant surgery. It has a high incidence in chronic inflammatory states including inflammatory bowel disease (IBD). The validity of existing data in IBD and of sarcopenia's correlation with surgical outcomes is limited.
We performed a systematic review to assess the correlation of sarcopenia with the requirement for surgery and surgical outcomes in patients with IBD. Observational studies of patients with IBD in whom an assessment of sarcopenic status/skeletal muscle index was undertaken, a proportion of whom proceeded to surgical management, were selected.
A total of 5 studies with a combined 658 IBD patients met the inclusion criteria. The majority (70%) had a diagnosis of Crohn's disease. Median (range) body mass index and skeletal muscle index were reported in 4 studies and were 16.58 (13.66-22.50) kg/m2 and 44.52 (42.90-50.64) cm2/m2, respectively. Forty-two percent of IBD patients had sarcopenia. Notably, none of the studies assessed both the anatomical and functional component required for a correct assessment of sarcopenia. Three studies noted that sarcopenic IBD patients had a higher probability of requiring surgery. The rate of major complications (Clavien-Dindo grade ≥IIIa) was significantly higher in patients with sarcopenia. Improved perioperative nutrition management may mitigate the risk of complications.
Many IBD patients are young, may be malnourished, and commonly require emergent surgery. There is considerable heterogeneity in the assessment of sarcopenia. Sarcopenia is common in the IBD population and can predict the need for surgical intervention. Sarcopenia correlates with an increased rate of major postoperative complications. Improved perioperative intervention may diminish this risk. A formal assessment, screening by a dedicated IBD dietician, and preoperative physical therapy may facilitate early intervention.
肌肉减少症与肿瘤学和移植手术中的发病率和死亡率增加有关。在包括炎症性肠病（IBD）在内的慢性炎症状态中，其发病率很高。IBD 中现有数据的有效性以及肌肉减少症与手术结果的相关性受到限制。
我们进行了一项系统评价，以评估 IBD 患者中肌肉减少症与手术需求和手术结果的相关性。选择了对 IBD 患者进行肌肉减少症状态/骨骼肌指数评估的观察性研究，其中一部分患者接受了手术治疗。
共有 5 项研究共纳入 658 例 IBD 患者符合纳入标准。大多数（70%）患者诊断为克罗恩病。4 项研究报告了中位数（范围）体重指数和骨骼肌指数，分别为 16.58（13.66-22.50）kg/m2 和 44.52（42.90-50.64）cm2/m2。42%的 IBD 患者有肌肉减少症。值得注意的是，没有一项研究评估了肌肉减少症评估所需的解剖学和功能成分。有 3 项研究指出，肌肉减少症的 IBD 患者更有可能需要手术。肌肉减少症患者的主要并发症（Clavien-Dindo 分级≥IIIa）发生率显著更高。改善围手术期营养管理可能会降低并发症的风险。
许多 IBD 患者年龄较小，可能存在营养不良，并且经常需要紧急手术。肌肉减少症的评估存在很大的异质性。肌肉减少症在 IBD 人群中很常见，可以预测手术干预的需求。肌肉减少症与术后主要并发症发生率增加相关。改善围手术期干预可能会降低这种风险。进行正式评估、由专门的 IBD 营养师进行筛查以及术前物理治疗可能有助于早期干预。
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