术前脂质代谢对胃肠手术患者围术期体重减轻和临床结局的影响  

Effect of pre-operative lipid metabolism on peri-operative weight loss and clinical outcomes after gastrointestinal surgery

作　　者：李超[1,2] 张玉[3] 王娟[1,2] 于康[3] 徐靖[1,2] Li Chao;Zhang Yu;Wang Juan;Yu KangXu Jing(Department of General Surgery,Tianjin Union Medical Center,the Affiliated Hospital of Nankai University,Tianjin300121,China;Tianjin Key Laboratory of General Surgery in construction,Tianjin Union Medical Center,Tianjin300121,China;Department of Clinical Nutrition&Health Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing100730,China)

机构地区：[1]天津市人民医院普通外科,天津300121 [2]天津市人民医院,天津市普通外科学重点建设学科实验室,天津300121 [3]中国医学科学院,北京协和医学院,北京协和医院临床营养科,北京100730

出　　处：《中华临床营养杂志》2024年第6期331-337,共7页Chinese Journal of Clinical Nutrition

基　　金：天津市医学重点学科(专科)建设项目资助(THYXZDXK-058B);天津市卫生健康委员会中医中西医结合科研重点课题(2023056);天津市人民医院院内课题(2024YJ008)。

摘　　要：目的旨在探索围术期体重减轻相关的危险因素及其与身体成分改变的相互作用。方法研究招募了2019年12月至2020年5月在天津市人民普通外科就诊的89例拟行胃肠手术的患者。通过CT测量患者腰三水平的骨骼肌和脂肪面积,比较了体重减轻组和非体重减轻组的身体成分。采用Logistic回归分析体重减轻尤其是身体成分变化与脂质代谢、营养状况、临床结局和医疗成本之间的关系。结果单因素分析发现,体重减轻组的血清前白蛋白水平较低(P=0.014),血清胆固醇水平较高(P=0.002),消化系统肿瘤的患病率较高(P=0.003),并且肿瘤淋巴浸润较多(P=0.046)。多因素Logistic回归分析显示,血清胆固醇水平是围术期体重减轻的危险因素(OR 1.711,95%CI 1.036~2.824,P=0.036)。血清胆固醇水平与骨骼肌质量呈显著负相关(r=-0.591,P=0.016)。此外,较高的血清胆固醇水平影响了手术患者的临床结局。结论较高的胆固醇水平与体重减轻,尤其是与骨骼肌质量降低有关。此外,体重减轻对外科手术患者的临床结局有不良影响。Objective We aim to investigate the risk factors related to peri-operative weight loss and analyze the interaction between changes in body composition and those risk factors.MethodsA total of 89 participants who visited the Department of General Surgery for planned gastrointestinal surgeries in Tianjin Union Medical Center from December 2019 to May 2020 were enrolled.Skeletal muscle area and fat area in CT images at L3 level were measured and compared between groups with and without weight loss.The relationships between weight loss(especially the changes in body composition)and lipid metabolism,nutritional status,clinical outcomes and medical costs were analyzed through logistic regression.ResultsUnivariate analysis found patients with weight loss had a lower serum pre-albumin level(P=0.014),a higher serum cholesterol level(P=0.002),a higher prevalence rate of digestive system carcinoma(P=0.003)and a higher proportion of patients with lymphatic infiltration(P=0.046).Multiple logistic regression showed that serum cholesterol level was a risk factor for peri-operative weight loss(OR=1.711,95%CI:1.036 to 2.824,P=0.036).In particular,there was a significant correlation between cholesterol level and skeletal muscle mass(r=-0.591,P=0.016).Moreover,multivariate analysis showed an impact of higher serum cholesterol level on the clinical outcomes in surgical patients.ConclusionsA higher cholesterol level is related with decreased body mass,especially skeletal muscle mass.Furthermore,weight loss had adverse effects on the clinical outcomes of surgical patients.

关 键 词：围术期体重减轻 胆固醇 外科手术 骨骼肌质量 

分 类 号：R656[医药卫生—外科学]