胃肠道良、恶性肿瘤患者围术期体重、骨骼肌及体脂肪变化比较

Perioperative changes of body weight,skeletal muscle and fat mass in patients with benign and malignant gastrointestinal tumors and the comparison

目的该文对胃肠道良、恶性肿瘤患者围术期体重及骨骼肌、体脂肪量变化进行描述和比较。方法连续定点选取北京某三级甲等医院基本外科胃肠道肿瘤择期手术成年患者,观察并比较良、恶性肿瘤患者围术期体重及人体成分的变化。结果共80例参加者完成研究。术前良、恶性肿瘤患者的体重和人体成分并无显著差异,但恶性肿瘤患者近6个月体重下降超过5%的比例明显高于良性肿瘤患者(42.0%比9.1%,P=0.024)。在采用肠外肠内营养支持的基础上,良性及不同分期恶性肿瘤患者在围术期的体重、肌肉、脂肪量的变化差异无统计学意义(均P>0.05)。将恶性肿瘤按是否有5%的体重下降分组,发现对照组的体重[(-4.3±1.6)kg比(-1.9±1.1)kg,P<0.01]、体重指数[(-1.3±0.9)kg/m^(2)比(-0.7±0.4)kg/m^(2),P<0.01]、骨骼肌量[(-1.2±2.0)kg比(-0.4±1.2)kg,P=0.046]、体脂肪量[(-2.6±2.0)kg比(-1.1±0.9)kg,P=0.018]减少程度均显著高于观察组,而内脏脂肪量[(-0.5±0.6)kg比(-0.2±0.7)kg,P=0.107]和皮下脂肪量[(-2.2±1.9)kg比(-1.4±1.8)kg,P=0.235]则差异无统计学意义。单因素分析显示,年龄是围术期体重下降的唯一影响因素(P=0.036)。恶性肿瘤患者体脂肪减少占比明显高于骨骼肌减少占比(P=0.026)。结论在肠外肠内营养支持的条件下,良、恶性肿瘤患者围术期体重、骨骼肌和体脂肪变化差异无统计学意义;在体重下降过程中,肌肉、脂肪均有显著减少,同样值得关注。

Objective To describe and compare the perioperative changes of body weight,skeletal muscle and fat mass in patients with benign and malignant gastrointestinal tumors.Methods All adult patients admitted to the surgery department of a referral hospital in Beijing with voluntary consent were included in the study.For all participants,preoperative medical history were collected and body composition measurements were performed 1-2 days prior to the surgery and 3-6 days after the surgery.Pathological results and tumor diagnosis were recorded.Results A total of 80 participants completed the study.There was no significant difference in weight and body composition between patients with benign and malignant tumors before operation,but patients experiencing a weight loss of more than 5%in the past 6 months were dramatically more in malignant tumor group compared with benign tumor group(9.1%vs.42.0%,P=0.024).With the parenteral and enteral nutrition support,there was no significant difference in the changes of weight,muscle,or fat mass between benign and malignant tumor patients in different stages(all P>.05).Patients with malignant tumors were divided into severe weight loss group and observational group with the percentage weight loss cut-off of 5%.Analysis showed that patients in the severe weight loss group had significantly decreased weight[(-4.3±1.6)kg vs.(-1.9±1.1)kg,P<0.01],BMI[(-1.3±0.9)kg/m^(2)vs.(-0.7±0.4)kg/m^(2),P<0.01],muscle[(-1.2±2.0)kg vs.(-0.4±1.2)kg,P=0.046]and fat mass[(-2.6±2.0)kg vs.(-1.1±0.9)kg,P=0.018]compared with observational group,while visceral[(-0.5±0.6)kg vs.(-0.2±0.7)kg,P=0.107]and subcutaneous fat[(-2.2±1.9)kg vs.(-1.4±1.8)kg,P=0.235]of two groups had no significant difference.Univariate analysis revealed age as the only influencing factor for perioperative weight loss(P=0.036).Fat loss was predominant in the overall weight loss compared with muscle loss(P=0.026)among patients with gastrointestinal malignant tumors.Conclusion With parenteral and enteral nutrition support,there is no significant difference in perioperative changes of weight,muscle or fat mass among patients with benign and malignant tumors.Muscle and fat loss both have contributed to the overall weight loss,which is noteworthy.