S S Petrikov, V V Kiselev, M S Zhigalova, R Sh Muslimov, P A Yartsev, L T Khamidova
{"title":"[腰肌密度作为胰腺坏死合并十二指肠外瘘患者营养缺乏的预后指标：一项初步研究]。","authors":"S S Petrikov, V V Kiselev, M S Zhigalova, R Sh Muslimov, P A Yartsev, L T Khamidova","doi":"10.17116/hirurgia202507146","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective. t: </strong>O assess severity of catabolism in patients with pancreatic necrosis complicated by external duodenal fistulas considering CT data of lumbar muscle density.</p><p><strong>Material and methods: </strong>A retrospective non-randomized pilot study included 11 patients (7 men (63.6%) and 4 women (36.4%)) diagnosed with severe acute pancreatitis and pancreatic necrosis. Late phase of disease was complicated by external duodenal fistulas in all patients. Mean age of patients ranged from 34 to 88 years (49 (34; 88) years). All patients were retrospectively assessed for lumbar muscle density at the level of the third lumbar vertebra using CT data (HUAC). Study stages: stage 1 - 24 hours after admission; stage 2 - 1.5±0.52 days after external duodenal fistula; stage 3 - 19.4±6.68 days after external duodenal fistula. The following parameters were retrospectively assessed in all patients: RPHU, RPA, LPHU, LPA. After that, mean lumbar muscle density (HUAC) was calculated. To assess prognostic significance of parameters, patients were divided depending on outcomes: group of survivors included 8 patients (<i>n</i>=8; 72.7%) aged 34-62 years; group of deceased included 3 patients (<i>n</i>=3; 27.3%) aged 63-88 years.</p><p><strong>Results: </strong>At the first stage (HUAC 1), values were was 34.69±8.44 (95% CI 26.89-42.50) HU and 31.35±6.76 (95% CI 14.57-48.14) HU, respectively (<i>p</i>=0.565). At the second stage (HUAC 2), mean values were 34.61±7.61 (95% CI 27.57-41.65) HU and 22.04±3.32 (95% CI 13.79-30.30) HU, respectively (<i>p</i>=0.028). Significant differences could indicate important changes in physiological state. At the third stage (HUAC 3), mean values were 37.14±7.21 (95% CI 30.47-43.80) HU and 19.44±3.51 (95% CI 10.71-28.16) HU, respectively (<i>p</i>=0.004).</p><p><strong>Conclusion: </strong>Despite the obvious importance of traditional methods for diagnosing nutritional deficiency, it is necessary to expand the list of perspective and more sensitive methods for prevention of nutritional disorders in patients with external duodenal fistulas. The proposed method for assessing the density of lumbar muscles has an important prognostic value and allows assessing the severity of catabolism upon admission and in follow-up period.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 7","pages":"46-58"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Lumbar muscle density as a prognostic marker of nutritional deficiency in patients with pancreatic necrosis complicated by external duodenal fistulas: a pilot study].\",\"authors\":\"S S Petrikov, V V Kiselev, M S Zhigalova, R Sh Muslimov, P A Yartsev, L T Khamidova\",\"doi\":\"10.17116/hirurgia202507146\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective. t: </strong>O assess severity of catabolism in patients with pancreatic necrosis complicated by external duodenal fistulas considering CT data of lumbar muscle density.</p><p><strong>Material and methods: </strong>A retrospective non-randomized pilot study included 11 patients (7 men (63.6%) and 4 women (36.4%)) diagnosed with severe acute pancreatitis and pancreatic necrosis. Late phase of disease was complicated by external duodenal fistulas in all patients. Mean age of patients ranged from 34 to 88 years (49 (34; 88) years). All patients were retrospectively assessed for lumbar muscle density at the level of the third lumbar vertebra using CT data (HUAC). Study stages: stage 1 - 24 hours after admission; stage 2 - 1.5±0.52 days after external duodenal fistula; stage 3 - 19.4±6.68 days after external duodenal fistula. The following parameters were retrospectively assessed in all patients: RPHU, RPA, LPHU, LPA. After that, mean lumbar muscle density (HUAC) was calculated. To assess prognostic significance of parameters, patients were divided depending on outcomes: group of survivors included 8 patients (<i>n</i>=8; 72.7%) aged 34-62 years; group of deceased included 3 patients (<i>n</i>=3; 27.3%) aged 63-88 years.</p><p><strong>Results: </strong>At the first stage (HUAC 1), values were was 34.69±8.44 (95% CI 26.89-42.50) HU and 31.35±6.76 (95% CI 14.57-48.14) HU, respectively (<i>p</i>=0.565). At the second stage (HUAC 2), mean values were 34.61±7.61 (95% CI 27.57-41.65) HU and 22.04±3.32 (95% CI 13.79-30.30) HU, respectively (<i>p</i>=0.028). Significant differences could indicate important changes in physiological state. At the third stage (HUAC 3), mean values were 37.14±7.21 (95% CI 30.47-43.80) HU and 19.44±3.51 (95% CI 10.71-28.16) HU, respectively (<i>p</i>=0.004).</p><p><strong>Conclusion: </strong>Despite the obvious importance of traditional methods for diagnosing nutritional deficiency, it is necessary to expand the list of perspective and more sensitive methods for prevention of nutritional disorders in patients with external duodenal fistulas. The proposed method for assessing the density of lumbar muscles has an important prognostic value and allows assessing the severity of catabolism upon admission and in follow-up period.</p>\",\"PeriodicalId\":35986,\"journal\":{\"name\":\"Khirurgiya\",\"volume\":\" 7\",\"pages\":\"46-58\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Khirurgiya\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.17116/hirurgia202507146\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Khirurgiya","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17116/hirurgia202507146","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目标。目的：结合腰肌密度的CT数据评估胰腺坏死合并十二指肠外瘘患者分解代谢的严重程度。材料和方法：一项回顾性非随机试验纳入11例诊断为严重急性胰腺炎和胰腺坏死的患者（7名男性（63.6%）和4名女性（36.4%））。所有患者在疾病晚期均并发十二指肠外瘘。患者平均年龄34 ~ 88岁(49岁；88年)。所有患者均采用CT资料（HUAC）回顾性评估第三腰椎水平的腰肌密度。研究阶段：第1阶段-入院后24小时；第2期：十二指肠外瘘后1.5±0.52天；第3期-十二指肠外瘘后19.4±6.68天。回顾性评估所有患者的以下参数：RPHU、RPA、LPHU、LPA。计算平均腰肌密度（HUAC）。为了评估参数的预后意义，根据结果对患者进行分组：幸存者组包括8例患者(n=8；72.7%)，年龄34-62岁；死亡组包括3例患者(n=3；27.3%)，年龄63-88岁。结果：第一阶段（HUAC 1）， HUAC值分别为34.69±8.44 (95% CI 26.89 ~ 42.50) HU和31.35±6.76 (95% CI 14.57 ~ 48.14) HU （p=0.565）。在第二阶段（HUAC 2），平均值分别为34.61±7.61 (95% CI 27.57 ~ 41.65) HU和22.04±3.32 (95% CI 13.79 ~ 30.30) HU （p=0.028）。差异显著可能预示着生理状态的重要变化。在第三阶段（HUAC 3），平均值分别为37.14±7.21 (95% CI 30.47 ~ 43.80) HU和19.44±3.51 (95% CI 10.71 ~ 28.16) HU （p=0.004）。结论：尽管传统方法诊断营养缺乏症的重要性明显，但有必要扩大视角和更敏感的方法来预防十二指肠外瘘患者的营养失调。所提出的评估腰肌密度的方法具有重要的预后价值，可以在入院时和随访期间评估分解代谢的严重程度。
[Lumbar muscle density as a prognostic marker of nutritional deficiency in patients with pancreatic necrosis complicated by external duodenal fistulas: a pilot study].
Objective. t: O assess severity of catabolism in patients with pancreatic necrosis complicated by external duodenal fistulas considering CT data of lumbar muscle density.
Material and methods: A retrospective non-randomized pilot study included 11 patients (7 men (63.6%) and 4 women (36.4%)) diagnosed with severe acute pancreatitis and pancreatic necrosis. Late phase of disease was complicated by external duodenal fistulas in all patients. Mean age of patients ranged from 34 to 88 years (49 (34; 88) years). All patients were retrospectively assessed for lumbar muscle density at the level of the third lumbar vertebra using CT data (HUAC). Study stages: stage 1 - 24 hours after admission; stage 2 - 1.5±0.52 days after external duodenal fistula; stage 3 - 19.4±6.68 days after external duodenal fistula. The following parameters were retrospectively assessed in all patients: RPHU, RPA, LPHU, LPA. After that, mean lumbar muscle density (HUAC) was calculated. To assess prognostic significance of parameters, patients were divided depending on outcomes: group of survivors included 8 patients (n=8; 72.7%) aged 34-62 years; group of deceased included 3 patients (n=3; 27.3%) aged 63-88 years.
Results: At the first stage (HUAC 1), values were was 34.69±8.44 (95% CI 26.89-42.50) HU and 31.35±6.76 (95% CI 14.57-48.14) HU, respectively (p=0.565). At the second stage (HUAC 2), mean values were 34.61±7.61 (95% CI 27.57-41.65) HU and 22.04±3.32 (95% CI 13.79-30.30) HU, respectively (p=0.028). Significant differences could indicate important changes in physiological state. At the third stage (HUAC 3), mean values were 37.14±7.21 (95% CI 30.47-43.80) HU and 19.44±3.51 (95% CI 10.71-28.16) HU, respectively (p=0.004).
Conclusion: Despite the obvious importance of traditional methods for diagnosing nutritional deficiency, it is necessary to expand the list of perspective and more sensitive methods for prevention of nutritional disorders in patients with external duodenal fistulas. The proposed method for assessing the density of lumbar muscles has an important prognostic value and allows assessing the severity of catabolism upon admission and in follow-up period.
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