免疫营养对胰腺十二指肠切除术后低骨骼肌量患者感染性并发症的影响。
Effect of immunonutrition on infectious complications in low skeletal muscle mass patients after pancreaticoduodenectomy.
机构信息
Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
出版信息
Clin Nutr. 2021 Jan;40(1):103-109. doi: 10.1016/j.clnu.2020.04.032. Epub 2020 Apr 28.
BACKGROUND & AIMS: Sarcopenia is considered a risk factor of postoperative complications among patients undergoing abdominal surgery. However, few studies have demonstrated an effective strategy for reducing complications in sarcopenic patients. This study aimed to examine retrospectively the effect of preoperative immunonutrition on postoperative complications, especially infectious complications, in low skeletal muscle mass patients undergoing pancreaticoduodenectomy (PD).
METHODS
This was a retrospective, consecutive cohort study conducted in our institution. Skeletal muscle mass was assessed using preoperative computed tomography images in 298 consecutive patients who underwent PD between May 2009 and May 2016. Cross-sectional areas at the third lumbar vertebrae normalized for stature (cm/m) were defined as the skeletal muscle mass index (SMI). Low SMI was defined as the lowest sex-specific quartile of SMI. Risk factors for postoperative infectious complications and the effect of preoperative immunonutrition on low SMI patients who underwent PD were evaluated.
RESULTS
Results of multivariate analysis showed that the presence of low SMI and absence of preoperative immunonutrition were independent risk factors for postoperative infectious complications after PD (odds ratio [OR], 3.17 and 3.10, respectively; P < 0.001). In high SMI patients, the rate of postoperative infectious complications was significantly lower in those who received immunonutrition than in those who did not receive immunonutrition (31.9 vs. 46.1%, respectively; OR, 1.82; P = 0.045). Further, similar findings were exhibited in low SMI patients (26.3 vs. 83.6%, respectively; OR, 14.31; P < 0.001), even though OR was markedly higher in low vs. high SMI patients.
CONCLUSION
There is a stronger association with reduced infectious complications in patients who have low SMI and receive immunonutrition (UMIN-CTR Identifier: UMIN000035775.).
背景与目的
肌少症被认为是接受腹部手术的患者术后并发症的一个风险因素。然而，很少有研究证明在肌少症患者中减少并发症的有效策略。本研究旨在回顾性地研究术前免疫营养对接受胰十二指肠切除术（PD）的低骨骼肌质量患者术后并发症，特别是感染性并发症的影响。
方法
这是一项在我院进行的回顾性连续队列研究。在 2009 年 5 月至 2016 年 5 月期间，对 298 例连续接受 PD 的患者使用术前 CT 图像评估骨骼肌质量。通过第三腰椎的横截面积除以身高（cm/m）定义为骨骼肌质量指数（SMI）。低 SMI 定义为 SMI 最低的性别四分位数。评估 PD 术后感染性并发症的危险因素及术前免疫营养对低 SMI 患者的影响。
结果
多因素分析结果显示，存在低 SMI 和缺乏术前免疫营养是 PD 术后感染性并发症的独立危险因素（比值比[OR]分别为 3.17 和 3.10；P<0.001）。在高 SMI 患者中，接受免疫营养的患者术后感染性并发症发生率明显低于未接受免疫营养的患者（分别为 31.9%和 46.1%；OR，1.82；P=0.045）。在低 SMI 患者中也观察到了类似的结果（分别为 26.3%和 83.6%；OR，14.31；P<0.001），尽管低 SMI 患者的 OR 明显高于高 SMI 患者。
结论
在接受免疫营养的低 SMI 患者中，感染性并发症减少的关联更强（UMIN-CTR 标识符：UMIN000035775）。
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