肿瘤患者肌肉减少症的诊治进展

Research progress on diagnosis and treatment of sarcopenia in tumor patients

肿瘤患者代谢异常,即肿瘤代谢重编程,是肿瘤发生发展的重要标志之一。肿瘤细胞快速生长的特性促使其争夺更多营养补给,高能量的需求和低获能的有氧糖酵解方式让机体功能蛋白被当作能源使用,导致体内蛋白质含量无法满足患者正常生理需要。全身的骨骼肌是人体最大的蛋白质储存库,肿瘤细胞复杂的营养代谢及蛋白质过度消耗会导致患者肌肉质量减少、肌肉功能下降。笔者团队最初研究发现,腹部肿瘤患者在经历了围术期的禁食及胃肠道手术改建等因素的影响后普遍会发生术后疲劳综合征,骨骼肌功能显著下降。通过进一步临床研究,无论是否存在营养风险,肌肉减少症都是胃肠肿瘤患者预后的独立预测因素。因此,肌肉减少症是肿瘤患者围术期的关注要点,将之纳入肿瘤患者的术前常规筛查亦具有重要临床意义。对合并肌肉减少症的肿瘤患者进行适当干预有助于促进术后加速康复,改善手术预后,对提高肿瘤患者术后生活质量和减轻公共医疗卫生负担具有重要意义。

Abnormal metabolism in tumor patients,known as the metabolic reprogramming of tumor is one of the key characteristics of tumorigenesis.The rapid-growth tumor is compelled to compete for more nutrient.The need for high energy and low-energy aerobic glycolysis allow the body s functional proteins to be used as energy,making it difficult to meet the normal physiological needs of patients.The complex nutritional metabolism of tumors and excessive protein consumption can reduce muscle mass and impair muscle function in cancer patients.The initial research of our team found that postoperative fatigue syndrome generally occurs in patients with abdominal tumors,and skeletal muscle function was significantly decreased after undergoing perioperative fasting and gastrointestinal surgery remodeling.Further clinical studies indicated that sarcopenia is an independent predictor of prognosis in patients with gastrointestinal tumors regardless of nutritional risk.Therefore,sarcopenia is an important concern for tumor patients during the perioperative period.It is of great clinical significance to include the diagnostic standard of sarcopenia in routine screening for tumor patients before surgery.It would enhance recovery after surgery and improve clinical outcomes if proper clinical interventions were carried out for the tumor patients with sarcopenia,and it would improve the life quality of tumor patients and reduce healthcare costs.