Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Endoscopic Medicine, Kobe University Hospital, Kobe, Japan.
Dis Esophagus. 2019 Aug 1;32(8). doi: 10.1093/dote/doz022.
Although treatment for esophageal motility disorder improves dysphagia and increases body weight, the effect of the treatment on body composition is unclear. This study aimed to assess the change in body composition between before and after treatment, the preoperative predictors of muscle increase, and the association between muscle increase and quality of life. Sixty-one patients (achalasia, n = 55; spastic esophageal disorder n = 6) who underwent per-oral endoscopic myotomy were analyzed in a single-arm prospective observational study. Appendicular skeletal muscle mass was measured with dual X-ray absorptiometry before and 3 months after per-oral endoscopic myotomy. For subgroup analysis, patients with postoperative appendicular skeletal muscle mass increase were defined as the muscle-increase group and the rest as the non-muscle-increase group. Preoperative factors related to the muscle-increase group were clarified via multivariate analysis. Further, the improvement after per-oral endoscopic myotomy in health-related quality-of-life score (Short Form-36) was compared between the muscle-increase and non-muscle-increase groups. Appendicular skeletal muscle mass increased significantly 3 months after per-oral endoscopic myotomy (P = 0.0002). The patients who underwent effective treatment (postoperative Eckardt score < 3) showed a significant improvement in appendicular skeletal muscle mass compared to those who did not (P = 0.04). In the stepwise logistic regression analysis, the preoperative Eckardt score (odds ratio: 1.95, 95% confidence interval 1.30-3.26, P = 0.0005) and preoperative serum prealbumin (odds ratio: 0.83, 95% confidence interval 0.70-0.97, P = 0.02) were identified as independent factors related to postoperative muscle increase. The improvements in the Short Form-36 domains of General Health (P = 0.0007) and Vitality (P = 0.003) were significantly higher in the muscle-increase group. The findings show that effective treatment improved the body composition of patients with esophageal motility disorder and that the Eckardt score and serum prealbumin may aid the prediction of increased appendicular skeletal muscle mass after treatment, resulting in a better quality of life.
虽然食管动力障碍的治疗可以改善吞咽困难和增加体重，但治疗对身体成分的影响尚不清楚。本研究旨在评估治疗前后身体成分的变化、肌肉增加的术前预测因素以及肌肉增加与生活质量之间的关系。61 例（贲门失弛缓症，n=55；痉挛性食管障碍，n=6）接受经口内镜肌切开术的患者进行了单臂前瞻性观察研究。在经口内镜肌切开术前和术后 3 个月，使用双能 X 线吸收法测量四肢骨骼肌质量。对于亚组分析，将术后四肢骨骼肌质量增加的患者定义为肌肉增加组，其余患者为非肌肉增加组。通过多变量分析明确了与肌肉增加组相关的术前因素。进一步比较了肌肉增加组和非肌肉增加组经口内镜肌切开术后健康相关生活质量评分（SF-36）的改善情况。经口内镜肌切开术后 3 个月，四肢骨骼肌质量显著增加（P=0.0002）。与未接受有效治疗（术后 Eckardt 评分<3）的患者相比，接受有效治疗的患者四肢骨骼肌质量显著改善（P=0.04）。在逐步逻辑回归分析中，术前 Eckardt 评分（比值比：1.95，95%置信区间 1.30-3.26，P=0.0005）和术前血清前白蛋白（比值比：0.83，95%置信区间 0.70-0.97，P=0.02）被确定为与术后肌肉增加相关的独立因素。肌肉增加组的 SF-36 一般健康（P=0.0007）和活力（P=0.003）领域的改善明显更高。研究结果表明，有效治疗改善了食管动力障碍患者的身体成分，Eckardt 评分和血清前白蛋白可能有助于预测治疗后四肢骨骼肌质量的增加，从而提高生活质量。
