结直肠腺瘤患者人体组成特点

目的 人体组成对结直肠腺瘤发病的影响尚不明确.本研究应用生物电阻抗分析(bioelectrical impedance analysis,BIA)检测结直肠腺瘤患者的人体组成,分析结直肠腺瘤的人体组成特点.方法 回顾性分析2014-01-01-2015-06 01香港大学深圳医院无症状行结肠镜筛查的患者292例,依据肠镜检查及息肉病理结果分为结直肠腺瘤组158例和正常对照组134例.记录吸烟、饮酒和药物服用史等,测量身高、体质量、腰围和臀围;应用BIA检测研究对象身体组成,比较结直肠腺瘤组与正常对照组在人体组成的差别,分析人体组成对结直肠腺瘤发病的影响.结果 结直肠腺瘤组腰围平均为(83.3±10.4) cm,高于正常对照组的(79.2±14.1) cm,P=0.015.在人体组成上,结直肠腺瘤组体脂率平均为(28.3±6.97)％,高于正常对照组的(26.2±6.41)％,P=0.034.结直肠腺瘤组腰臀脂肪比平均为0.91±0.065,正常对照组平均为0.88±0.059,P=0.024.结直肠腺瘤组患者体脂率超标的比例为75.9％,高于正常对照组的59.7％,P=0.003.结直肠腺瘤组腰臀脂肪比超标的比例为68.8％,正常对照组为56.7％,P=0.041.结论 结直肠腺瘤患者腰围增加,人体组成以体脂率和腰臀脂肪比升高为特征.     

不同年龄绝经后妇女身体软组织含量与骨密度相关性的研究

目的 探讨身体软组织含量和骨密度之间的关系。方法 选择62例绝经期健康日本妇女,应用双能X-线法(DXA)测定其第2-4腰椎、双侧股骨转子间和桡骨中、下1/3交界处骨密度(BMD),同时测定身体肌肉组织、脂肪组织含量,并对软组织含量与身体各部位的BMD进行相关性分析。结果 全身肌肉重量及体重与正位腰椎BMD呈正相关(r=0.45及0.35),而脂肪百分比与腰椎、股骨转子间和桡骨远端BMD呈负相关(r=-0.17)。随着年龄增长,BMD呈下降趋势,60岁组与50岁及70岁组比较差异有显著意义(分别为P<0.01及P<0.05)。结论 身体内软组织含量中肌肉重量、体重与全身各部位的BMD有相关性,其中体重和肌肉重量与腰椎BMD的相关性较好,脂肪重量与BMD的相关性不明显。     

生物电阻抗分析技术在肿瘤患者人体成分分析中应用研究

目的 采用生物电阻抗分析技术进行人体成分分析在临床中应用已越来越广泛,本研究采用两款人体成分分析 仪对肿瘤患者进行体成分的测定,为人体成分分析仪在肿瘤患者中的应用提供参考依据。方法 采用营养风险筛查量表进 行营养风险筛查,采用患者主观整体营养评估量表进行营养评估,采用 IOI 353 人体成分分析仪和BCA-2A 人体成分分析 仪检测肿瘤患者的体成分,包括：体重、体质指数、骨量、内脏脂肪水平、肌肉量、基础代谢、体脂肪率、体水分率等指 标,应用线性回归法分析两款仪器测量结果间的一致性。结果 纳入符合标准的肿瘤患者110 例,48 例（44%）患者NRS 2002 ≥ 3 分;61 例（56%）患者PG-SGA 评价为B 级,31 例（28%）患者评价为C 级;两款仪器的成对定量数据相关系 数 r ＞ 0.975,两者之间有良好相关性,成对定量分析数据进行分析无明显差异（P ＞ 0.05）,即两款仪器之间存在等效性 关系。结论 肿瘤患者营养风险和营养不良发生率较高,应及早进行营养风险筛查和营养评估,不同品牌人体成分分析仪等 效性较好。     

身体质量指数及腰臀围比与胆道癌关系的探讨

目的:探讨身体质量指数(BMI)、腰臀围比(WHR)与胆道癌的关系.方法:采用非条件logistic回归模型分析身体质量指数、腰臀围比与胆道癌的关系.结果:与正常BMI组比较,胆囊癌女性20～29岁、30～39岁肥胖组的OR与趋势检验均达到或接近显著水平.与腰臀围比四分位最低组比较,胆囊癌和肝外胆管癌男女性最高四分位组OR和趋势检验均达到显著水平.结论:青年时期肥胖可能会增加胆囊癌的发病风险;腰臀围比也是胆囊癌和肝外胆管癌独立的危险因素.     

生酮饮食对肥胖影响的研究

目的 探讨生酮减脂对体重、体脂、内脏脂肪等的作用。方法 本研究通过募集符合入组标准的减脂人士,根据 生酮饮食的基本原理,对减脂人士进行饮食管理,采用“柔性生酮”的方式,不经过禁食过程,直接切换为生酮饮食。生 酮饮食三大营养素配比为可利用碳水化合物12g左右,蛋白质1g/kg体重,其他以脂肪补充,至总供给能量约等于基础代谢, 除富含中链脂肪酸的椰子油外,脂肪供应种类不限。定期人体成分分析动态观察体重、骨骼肌重量、体脂率、体脂等,定 期进行人体学测量,计算腰臀比。结果 减脂人士从第一周开始即出现体重的明显下降,4 周累计下降（3.99±2.29）kg,体 脂保持持续下降和生酮减脂持续时间正相关：y=1.32423+0.37536*x,R2=0.81966。同时生酮减脂能够有效降低减脂人士的 腰臀比（y=0.016+0.00476*x,R2=0.61009）。结论  生酮减脂对体脂和腰臀比减少效果明显,且和持续时间正相关。生酮治 疗已有近百年的临床应用历史,适应证从癫痫逐步扩展到体重管理,肿瘤等多个领域。     

围化疗期的胃肠外营养支持(六)

疗效评价方法可通过采用营养状况评价方法判定化疗前后病人的营养状况来评判围化疗期使用人工胃肠营养支持治疗的结果。营养状况评价方法有两种：身体组成评价法和主观的全面评价法。一、身体组成评价法该方法由临床检查、人体测量和实验室检查三部分组成。分别对人体的脂肪、骨骼。骨骼肌、皮肤、血浆和内脏六个组成成份进行不同参数的评价,并综合以上参数对整个机体的营养状况进行评判。热量主要储存于脂肪和骨骼肌,蛋白质主要分布在皮肤、骨骼。血浆、内脏和骨骼肌。脂肪储存量和内脏及骨骼肌的蛋白质可以通过适当的参数予以评价。1．…     

磁共振成象对成人早期霍奇金病放射治疗疗效的评估价值

目的　测量 60例成人早期霍奇金病 (HD)放疗前后磁共振成像 (MRI)信号强度 (SI)的变化 ,标定放疗后肿瘤组织纤维化的程度 ,从而准确评估放疗对成人早期HD的疗效。方法　应用MRI的自动测量系统 ,在放疗前后分别测量肿瘤、皮下脂肪及肌肉的SI ,分别用脂肪和肌肉的SI除以肿瘤的相应测量值而得到标准化值。结果　放疗后肿瘤SI的脂肪和肌肉的标准化值的均数及标准差分别为 0 .4± 0 .3和 1.8± 1.2 ,比放疗前的标准化值明显减小 (P值 <0 .0 1)。结论　MRISI的测量可准确评估成人早期HD的放疗效果 ,其T2 加权图像 (T2 WI)可对纤维组织和残留或复发的肿瘤组织作出鉴别。     

口腔舌厚度与舌鳞状细胞癌淋巴结转移的关系

目的 探讨口腔舌厚度与舌鳞状细胞癌淋巴结转移及预后的关系.方法 采用三步法,检测96例舌鳞状细胞癌患者口腔舌厚度.结果 口腔舌厚度测量值与患者年龄、性别、肿瘤大小、肿瘤部位、侵袭深度,肿瘤分期及分化程度、是否转移等并不存在相关性(P＞0.05);而淋巴结受累者口腔舌厚度测量值明显上调(P＜0.05),而无淋巴结受累者其测量值与正常组相比差异无统计学意义(P＞0.05),口腔舌厚度测量值的增加与淋巴结受累有关.结论 口腔舌厚度测量值水平与舌鳞状细胞癌的淋巴结转移及预后有一定的相关性,但还需进一步系统研究.     

黏液型脂肪肉瘤的影像学与临床病理联系

目的:探讨下肢肌肉间原发性黏液型脂肪肉瘤的影像学表现、病理特点及其联系.提高对原发性脂肪肉瘤的诊治水平.方法:报道3例大腿肌肉内原发性脂肪肉瘤,依据WHO脂肪肉瘤分类标准诊断和分型.采用计算机断层扫描(CT)及磁共振成像(MRI)进行影像学观察,采用平滑肌特异性肌动蛋白(SMA)、CD31、CD34、CD99和S-100等抗体进行免疫组织化学染色观察,并复习文献.结果:3例患者均以下肢进行性增大的肌肉内包块为首发症状,术前CT检查肌肉内界限清楚的低密度影,MRI显示长T1和长T2弛豫时间表现.影像学检查缺乏特异性诊断,不易分辨肿物性质及区分良恶性.组织形态上,有不同成熟阶段的脂肪母细胞组成,部分区域具有"肺水肿样"特征.肿瘤细胞呈S-100、CD99阳性.结论:肌肉内原发性脂肪肉瘤.以黏液样型多见,因该肿瘤富含脂肪,常伴有黏液变性或水肿("肺水肿样"表现),在CT成像时,往往出现低密度水肿样影像,MRI表现为长T1,长T2成像与其他良性肿瘤鉴别困难.因此,有必要采用MRI钆剂增强显影并结合病理学诊断以利确诊.     

老年高血压患者生物电阻抗相位角与营养状况的相关性研究

目的 研究老年高血压患者生物电阻抗相位角(PA)与营养状况的关系,探讨其评估患者营养状况的可行性。方法选取连云港市第一人民医院2021年1月至12月入院的老年高血压患者415例,进行一般资料收集、营养风险筛查、营养评估、人体测量、人体成分分析、血生化检查,采用病例对照研究,按相位角数值将患者分为正常PA组和低PA组,分析PA与各营养指标的关系。结果 低PA组存在营养风险及营养不良的比例高于正常PA组(P<0.05)。低PA组体重、体质指数、上臂围、腰围、臀围、舒张压、握力、步速、骨骼肌量、体脂百分比、四肢骨骼肌量(ASM)、四肢骨骼肌质量指数(ASMI)、血红蛋白、白蛋白、总胆固醇、甘油三酯、低密度脂蛋白胆固醇均低于正常PA组(P<0.05)。相关性分析显示,PA与体脂百分比呈负相关(r=-0.321,P<0.05),与体重(r=0.231)、体质指数(r=0.132)、上臂围(r=0.381)、臀围(r=0.135)、握力(r=0.274)、步速(r=0.192)、骨骼肌量(r=0.499)、ASM(r=0.464)、ASMI(r=0.562)、血红蛋白(r=0.3...     

Bicalutamide monotherapy versus leuprolide monotherapy for prostate cancer: effects on bone mineral density and body composition.

PURPOSE: Gonadotropin-releasing hormone agonists decrease bone mineral density, lean mass, and muscle size and increase fat mass in men with prostate cancer. Less is known about the effects of bicalutamide monotherapy on bone mineral density and body composition. PATIENTS AND METHODS: In a 12-month, open-label study, we randomly assigned 52 men with prostate cancer and no bone metastases to receive either leuprolide or bicalutamide (150 mg by mouth daily). Bone mineral density and body composition were measured by dual energy x-ray absorptiometry and quantitative computed tomography. RESULTS: Mean (+/- standard error) bone mineral density of the posterior-anterior lumbar spine decreased by 2.5% +/- 0.5% in the leuprolide group and increased by 2.5 +/- 0.5 in the bicalutamide group from baseline to 12 months (P <.001). Mean changes in bone mineral density of the total body, total hip, femoral neck, and trabecular bone of the lumbar spine also differed significantly between groups (P < or =.003 for each comparison). Fat mass increased by 11.1% +/- 1.3% in the leuprolide group and by 6.4% +/- 1.1% in the bicalutamide group (P =.01). Changes in lean mass, muscle size, and muscle strength were similar between the groups. Breast tenderness and enlargement were more common in the bicalutamide group than in the leuprolide group. Fatigue, loss of sexual interest, and vasomotor flushing were less common in the bicalutamide group than in the leuprolide group. CONCLUSION: In men with prostate cancer, bicalutamide monotherapy increases bone mineral density, lessens fat accumulation, and has fewer bothersome side effects than treatment with a gonadotropin-releasing hormone agonist.     

Osteoporosis and other adverse body composition changes during androgen deprivation therapy for prostate cancer

Osteoporosis and other body composition changes are important complications of androgen deprivation therapy (ADT) for prostate cancer. Bilateral orchiectomy and gonadotropin-releasing hormone agonist treatment decrease bone mineral density and increase fracture risk. Other factors including diet and lifestyle may contribute to bone loss in men with prostate cancer. Estrogens play an important role in male bone metabolism. Androgen deprivation therapy with estrogens probably causes less bone loss than bilateral orchiectomy or gonadotropin-releasing hormone agonist treatment. Bicalutamide monotherapy increases serum estrogen levels and may also spare bone. Lifestyle modification including smoking cessation, moderation of alcohol use, and regular weight bearing exercise are recommended to decrease treatment-related bone loss. Supplemental calcium and vitamin D are also recommended. Pamidronate (Aredia®), an intravenous bisphosphonate, prevents bone loss during ADT. Other bisphosphonates are probably effective but have not been studied in hypogonadal men. Androgen deprivation therapy increases fat mass and decreases muscle mass. These body composition changes may contribute to treatment-related decreases in physical capacity and quality of life.     

A phase III clinical trial of exercise modalities on treatment side-effects in men receiving therapy for prostate cancer

Background  

Androgen deprivation therapy (ADT) is accompanied by a number of adverse side effects including reduced bone mass and increased risk for fracture, reduced lean mass and muscle strength, mood disturbance and increased fat mass compromising physical functioning, independence, and quality of life. The purpose of this investigation is to examine the effects of long term exercise on reversing musculoskeletal-related side effects, and cardiovascular and diabetes risk factors in men receiving androgen deprivation for their prostate cancer. Specifically, we aim to investigate the effects of a 12-month exercise program designed to load the musculoskeletal system and reduce cardiovascular and diabetes disease progression on the following primary endpoints: 1) bone mineral density; 2) cardiorespiratory function and maximal oxygen capacity; 3) body composition (lean mass and fat mass); 4) blood pressure and cardiovascular function; 5) lipids and glycemic control; and 6) quality of life and psychological distress.     

胃肠道恶性肿瘤患者的人体成分分析

目的 分析胃肠道肿瘤患者的人体成分,探讨人体成分指标在评估胃肠道肿瘤患者营养状况中的价值。方法 纳入拟行手术治疗的胃肠道恶性肿瘤患者162例,入院行主观综合营养评估（SGA）和生物电阻抗体成分分析。结果 低去脂指数、低骨骼肌指数和细胞外水肿的发生率均为1/4左右,其中20%以上为SGA评为营养良好的患者。体成分指标与SGA评估营养不良的一致性均差,但低脂肪指数与SGA的一致性在男性患者中更好,而低骨骼肌指数与SGA的一致性在女性患者中更好。相位角<4°的患者,评定为低体重指数、低去脂指数、低骨骼肌指数、细胞外水肿、营养不良、重度营养不良和低蛋白血症的特异性高达98%以上。结论 有必要结合人体成分指标来评估胃肠道肿瘤患者的营养状况;人体成分指标在评判营养不良时存在性别差异;相位角＜4°在全面地评定营养不良方面具高特异性。     

Changes in bone mineral density and body composition during initial and long-term gonadotropin-releasing hormone agonist treatment for prostate carcinoma

BACKGROUND: Initial treatment with a gonadotropin-releasing hormone (GnRH) agonist increases fat mass, decreases lean body mass, and decreases bone mineral density (BMD) in men with prostate carcinoma. To the authors' knowledge, little is known regarding either the long-term effects of treatment or predictors of treatment-related changes in BMD and body composition. METHODS: The authors analyzed prospective 12-month data from 65 men during initial and long-term GnRH agonist treatment for prostate carcinoma. Relationships between baseline characteristics (age, treatment duration, body mass index, and baseline values for outcome of interest) and changes in lean mass, fat mass, and BMD were assessed using univariate and multivariate regression models. RESULTS: Mean BMD of total hip decreased by 1.9 +/- 2.7%, lean body mass decreased by 2.0 +/- 3.3%, and fat mass increased by 6.6 +/- 9.4% at 12 months (P < 0.001 for each comparison). Twenty-three men (35%) had received treatment with a GnRH agonist before study entry, and the mean (+/- standard deviation) duration of previous treatment was 35 +/- 41 months. Longer duration of previous GnRH agonist treatment was found to independently predict less fat accumulation and less loss of lean body mass in multivariate models. In contrast, the duration of GnRH agonist treatment did not significantly predict changes in BMD. Other covariates did not appear to predict changes in body composition or BMD consistently. CONCLUSIONS: The results of the current study showed that fat mass increased and lean body mass decreased mostly during initial GnRH agonist therapy whereas BMD decreased steadily during initial and long-term treatment.     

Musculoskeletal changes after 1 year of exercise in older breast cancer survivors

Introduction

We have previously reported that 1 year of supervised resistance?+?impact training stopped bone loss and built muscle strength in older breast cancer survivors. The purpose of this study was to determine whether these benefits persisted 1 year after completion of the intervention.

Methods

Sixty-seven women from the original trial completed baseline and post-intervention body composition and muscle strength tests, and 44 women were available 1 year later for follow-up assessments. Bone mineral density (grams per square centimeter) of the hip and spine, muscle mass (kilograms), and fat mass (kilograms) were measured by dual-energy X-ray absorptiometry and maximal upper and lower body strength were measured by one-repetition maximum tests (kilograms). We compared between group changes across baseline (pre-intervention), 1 (post-intervention), and 2 years (1 year follow up) on study outcomes using repeated-measures analysis of covariance, adjusting for age.

Results

Significant group by time interactions were found for spine bone mineral density (BMD) (p?<?0.01) and lower body muscle strength (p?<?0.05), with a trend for upper body muscle strength (p?=?0.05). Spine BMD remained stable across intervention and follow-up periods in exercisers compared with continuous losses in controls across 1- and 2-year periods. In contrast, lower body strength increased in exercisers across the intervention, but decreased to near-baseline levels during follow-up compared with no change over either time period in controls.

Conclusions

Our data suggest that spine BMD can be preserved in older breast cancer survivors even after formal exercise training stops; however, muscle strength is not similarly maintained and may require continued participation in a supervised exercise program.

Implications for Cancer Survivors

Exercise programs aimed at improving musculoskeletal health should be considered in the long-term care plan for breast cancer survivors.     

The relationship between the GLIM-defined malnutrition,body composition and functional parameters,and clinical outcomes in elderly patients undergoing radical gastrectomy for gastric cancer

ObjectiveThe present study aims to determine the correlations between Global Leadership Initiative in Malnutrition (GLIM)-defined malnutrition and body composition and functional parameters, and to comprehensively analyze the predictive value of GLIM-defined malnutrition for postoperative outcomes in the context of detailed measurement of body composition and functional parameters in elderly patients who underwent radical gastrectomy for gastric cancer.MethodsElderly patients (aged ≥65 years) who underwent radical gastrectomy for gastric cancer from August 2014 to June 2019 were included. Malnutrition was diagnosed using the GLIM criteria. Skeletal muscle index (SMI), skeletal muscle density (SMD), subcutaneous fat area (SFA), and visceral fat area (VFA) were analyzed using abdominal computed tomography (CT) images. Handgrip strength and 6-m gait speed were measured.ResultsA total of 597 elderly patients were included in this study, in which 45.7% were at risk of malnutrition identified using Nutritional Risk Screening 2002 (NRS 2002), and 34.5% were diagnosed with malnutrition. Patients with malnutrition had lower SMI, SMD, SFA, VFA, lower handgrip strength and gait speed. Low handgrip strength and age ≥80 years were independent risk factors for postoperative complications, rather than GLIM-defined malnutrition. GLIM-defined malnutrition was independently associated with overall survival and disease-free survival after adjusting to the body composition and functional parameters in the multivariate analyses.ConclusionsGLIM-defined malnutrition was a better predictive factor than single parameters of body composition or physical function for survival in elderly gastric cancer patients. Handgrip strength can be used as a supportive measure to further improve the definition of malnutrition.     

Low bone density and high percentage of body fat among men who were treated with androgen deprivation therapy for prostate carcinoma

BACKGROUND: Men with prostate carcinoma who are treated with androgen deprivation therapy (ADT) are reported to be at an increased risk of bone loss and weight changes due to the sudden disruption of hormonal levels. In the current case-control study, the authors examined the prevalence and magnitude of low bone density and obesity among men with prostate carcinoma who were treated with ADT. METHODS: Sixty-two men with prostate carcinoma who had been receiving ADT for 1-5 years were included as cases. Healthy men (n = 47) with a prostate specific antigen level < 4.0 ng/mL were recruited as controls. Body composition and bone mineral density (BMD) were measured using dual-energy X-ray absorptiometry. The average age was 74.3 years for the cases and 72.8 years for the controls. RESULTS: The results of the current study demonstrate that prostate carcinoma cases had significantly higher body weight (86.5 kg vs. 80.6 kg), a higher percentage of body fat (30% vs. 26%), and a lower total body BMD (1.12 mg/cm(2) vs. 1.17mg/ cm(2)) compared with controls (P < 0.05). Cases were more likely to be obese (27.4% vs 43%) and have low BMD at trochanter (32.3% vs. 10.6%), intertrochanter (48.4% vs. 29.8%), and total hip measurements (50.0% vs. 25.3%). CONCLUSIONS: The results of the current study indicate that men with prostate carcinoma who are treated with ADT have a significantly increased risk of low bone density and obesity.     

综合性运动训练预防前列腺癌患者雄激素剥夺疗法的副作用

目的:探讨在雄激素剥夺疗法（ADT）开始的同时进行综合运动干预能否降低前列腺癌患者ADT的副作用。方法:70例开始使用醋酸亮丙瑞林(lucrin)进行治疗的前列腺癌患者随机分为运动组和对照组,每组35例。运动组开展包括抗阻训练、有氧运动和冲击加载运动,每周3次,连续3个月。对照组不进行运动干预。在开始干预前（基线期）和干预后(3个月)评估患者身体组成成分、骨密度、身体机能、血生化指标和基于SF-36、QLQ-PR25、FACIT-Fatigue、BSI-18等量表评价的健康相关生活质量。采用协方差分析(ANCOVA)比较调整了组间差异后干预前后各变量的变化情况。结果:运动干预3个月后,与基线期相比较,试验组的四肢瘦体组织［ 95%CI:0.4(0.1~0.7) kg,P=0.029］和全身瘦体组织［ 95%CI:0.7(0.1~1.6) kg,P=0.054］在调整了组间差异后均有显著增加。而运动组全身脂肪量及其比例、躯干脂肪量在调整组间差异后均有降低 (P＜0.01或P＜0.001)。与对照组比较,试验组患者的股骨颈变化值［ 95%CI:0.012(0.005~0.024) kg,P=0.032］、胫骨骨密度变化值［ 95%CI:20.0(12.5~29.5) kg,P=0.019］差异有统计学意义。与对照组比较,试验组在心肺功能(VO2 peak)、上肢肌肉和下肢肌肉的最大力量（胸部推举、腿部推蹬和坐姿划船）、肢体功能（椅子起立试验）方面均有显著的改善（P＜0.05或P＜0.01）。两组间在行走能力、平衡能力和平衡信心方面得分差异无统计学意义（P＞0.05）。组间总胆固醇/HDL比值差异有统计学意义（P=0.027）。干预后患者性功能和疲劳感也得到了改善。结论:当开始ADT的同时启动包括有氧运动、抗阻运动和冲击加载运动的综合性运动计划,可以改善患者身体成分、身体功能、总胆固醇/HDL比例、性功能、疲劳严重程度。本研究扩展了运动干预对于改善ADT治疗前列腺癌的副作用的有效性的证据。