肝癌患者围手术期肌肉减少症防治的研究进展

摘要/Abstract

摘要： 肝癌患者是肌肉减少症的高发人群。本文围绕肌肉减少症的概念、肝癌患者肌肉减少症的评估诊断及肝癌患者围手术期肌肉减少症的防治措施三个方面进行综述,旨在为改善肝癌患者肌肉减少症相关不良预后,提高肝癌患者术后生存率提供参考。

Abstract: Patients with liver cancer are at high risk of sarcopenia. This article reviews the concept of sarcopenia, the assessment and diagnosis of sarcopenia in liver cancer patients, and the prevention and treatment measures for sarcopenia in the perioperative period of liver cancer patients. The aim is to provide references for improving the adverse prognosis related to sarcopenia in liver cancer patients and increasing the postoperative survival rate of liver cancer patients.

Key words: Liver cancer, Perioperative period, Sarcopenia, Prevention and treatment

杨宁, 张明名, 王海娇, 王欣然. 肝癌患者围手术期肌肉减少症防治的研究进展[J]. 肝癌电子杂志, 2026, 13(3): 73-76.

Yang Ning, Zhang Mingming, Wang Haijiao, Wang Xinran. Research progress on the prevention and treatment of perioperative sarcopenia in patients with liver cancer[J]. Electronic Journal of Liver Tumor, 2026, 13(3): 73-76.

参考文献

[1] Cruz-jentoft AJ, Sayer AA. Sarcopenia[J]. Lancet, 2019, 393(10191): 2636-2646.
[2] Wu DH, Liao CY, Wang DF, et al.Textbook outcomes of hepatocellular carcinoma patients with sarcopenia: a multicenter analysis[J]. Eur J Surg Oncol, 2023, 49(4): 802-810.
[3] Imai K, Takai K, Watanabe S, et al.Sarcopenia impairs prognosis of patients with hepatocellular carcinoma: the role of liver functional reserve and tumor-related factors in loss of skeletal muscle volume[J]. Nutrients, 2017, 9(10): 1054.
[4] Utsumi M, Inagaki M, Kitada K, et al.Predictive values of sarcopenia and systemic inflammation-based markers in advanced hepatocellular carcinoma after hepatectomy[J]. Asian J Surg, 2024, 47(7): 3039-3047.
[5] Berardi G, Atonelli G, Colasanti M, et al.Association of sarcopenia and body composition with short-term outcomes after liver resection for malignant tumors[J]. JAMA Surg, 2020, 155(11): e203336.
[6] Xu X, Pan X, Chen H, et al.Sarcopenia's increasingly vital role in liver cancer[J]. Hepatobiliary Surg Nutr, 2025, 14(2): 326-328.
[7] Rosenberg IH.Summary comments[J]. Am J Clin Nutr, 1989, 50: 1231-1233.
[8] Cruz-jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People[J]. Age Ageing, 2010, 39(4): 412-423.
[9] Cruz-jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(4): 601.
[10] Kirk B, Cawthon PM, Arai H, et al. The conceptual definition of sarcopenia: Delphi consensus from the Global Leadership Initiative in Sarcopenia (GLIS)[J]. Age Ageing, 2024, 53(3): afae052.
[11] 中华医学会老年医学分会, 国家老年疾病临床医学研究中心(湘雅医院). 中国肌肉减少症诊疗指南(2024版)[J]. 中华医学杂志, 2025, 105(3): 181-203.
[12] 马耀, 赵力博, 刘霖. 肌肉减少症发生机制研究进展[J]. 中华保健医学杂志, 2025, 27(6): 1099-1104.
[13] Tandon P, Low G, Mourtzakis M, et al.A model to identify sarcopenia in patients with cirrhosis[J]. Clin Gastroenterol Hepatol, 2016, 14(10): 1473-1480.
[14] Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia:2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3): 300-307.e2.
[15] 张睿, 高超, 王戬萌, 等. 超声在肌少症患者诊断中的应用进展[J]. 中华老年医学杂志, 2024, 43(12): 1551-1555.
[16] 崔华, 王朝晖, 吴剑卿, 等. 老年人肌少症防控干预中国专家共识(2023)[J]. 中华老年医学杂志, 2023, 42(2): 144-153.
[17] 中华医学会器官移植学分会肝移植学组, 中国医师协会器官移植医师分会. 中国肝移植受者肌肉减少症临床诊疗指南[J/OL]. 中华移植杂志(电子版), 2024, 18(6): 355-365.
[18] Guralnik JM, Ferrucci L, Pieper CF, et al.Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery[J]. J Gerontol A Biol Sci Med Sci, 2000, 55(4): M221-M231.
[19] 中华医学会老年医学分会. 老年患者6分钟步行试验临床应用中国专家共识[J]. 中华老年医学杂志, 2020, 39(11): 1241-1250.
[20] Nishikawa H, Shiraki M, Hiramatsu A, et al.Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): recommendation from the Working Group for Creation of Sarcopenia Assessment Criteria: sarcopenia assessment criteria in liver disease[J]. Hepatol Res, 2016, 46: 951-963.
[21] Wells CI, Mccall JL, Plank LD.Relationship between total body protein and cross sectional skeletal muscle area in liver cirrhosis is influenced by overhydration[J]. Liver Transpl, 2019, 25(1): 45-55.
[22] Carey EJ, Lai JC, Sonnenday C, et al.A North American expert opinion statement on sarcopenia in liver transplantation[J]. Hepatology, 2019, 70(5): 1816-1829.
[23] Guo WP, Zhang HY, Liu LX.Risk factors of hepatocellular carcinoma in non-alcoholic fatty liver disease: a systematic review and meta-analysis[J]. Eur Rev Med Pharmacol Sci, 2023, 27(24): 11890-11903.
[24] 李娜, 宋瑞梅, 刘晓丽, 等. 腹腔镜下肝癌切除术患者预康复策略应用研究进展[J]. 同济大学学报(医学版), 2024, 45(6): 926-932.
[25] 吴洪苇, 王兆北, 杨文晴, 等. 成人肝癌患者营养筛查与营养支持的最佳证据总结[J]. 上海护理, 2026, 26(2): 47-52.
[26] 中国抗癌协会肿瘤营养专业委员会. 口服营养补充的指南更新[J/OL]. 肿瘤代谢与营养电子杂志, 2023, 10(1): 64-68.
[27] 中国抗癌协会肝胆肿瘤整合护理专业委员会, 中国抗癌协会整合肝癌委员会. 原发性肝癌肝切除术患者围手术期营养管理专家共识(2025版)[J]. 中华消化外科杂志, 2025, 24(12): 1539-1547.
[28] Anandavedivelan P, Cardinale D, Blomhoff R, et al.Blood flow restriction exercise in the perioperative setting to prevent loss of muscle mass in patients with pancreatic, biliary tract, and liver cancer: study protocol for the PREV-Ex randomized controlled trial[J]. Trials, 2024, 25(1): 356.
[29] Yu K, Yin B, Zhu Y, et al.Efficacy of a digital postoperative rehabilitation intervention in patients with primary liver cancer: randomized controlled trial[J]. JMIR Mhealth Uhealth, 2025, 13: e59228.
[30] Perisetti A, Goyal H, Yendala R, et al.Sarcopenia in hepatocellular carcinoma: current knowledge and future directions[J]. World J Gastroenterol, 2022, 28(4): 432-448.
[31] Tai H, Morishita A, Tadokoro T, et al.Optimizing nutrition to counter sarcopenia in hepatocellular carcinoma: a narrative review of mechanisms, clinical consequences, and supportive therapeutic options[J]. Nutrients, 2026, 18(3): 494.
[32] Berardi G, Cucchetti A, Colasanti M, et al.Prehabilitation with exercise and nutrition to reduce morbidity of major hepatectomy in patients with sarcopenia: the PREHEP randomized clinical trial[J]. JAMA Surg, 2025, 160(10): 1068-1075.
[33] Davis MP, Panikkar R.Sarcopenia associated with chemotherapy and targeted agents for cancer therapy[J]. Ann Palliat Med, 2019, 8(1): 86-101.
[34] 马金栋, 焦向飞, 蔡婷婷, 等. 肌肉减少症与肝癌研究进展[J/OL]. 中华临床医师杂志(电子版), 2023, 17(3): 356-359.
[35] Gkekas NK, Anagnostis P, Paraschou V, et al.The effect of vitamin D plus protein supplementation on sarcopenia: a systematic review and meta-analysis of randomized controlled trials[J]. Maturitas, 2021, 145: 56-63.
[36] Chrysavgis L, Adamantou M, Angelousi A, et al.The association of testosterone with sarcopenia and frailty in chronic liver disease[J]. Eur J Clin Invest, 2024, 54(2): e14108.
[37] Dasarathy S, Merli M.Sarcopenia from mechanism to diagnosis and treatment in liver disease[J]. J Hepatol, 2016, 65(6): 1232-1244.
[38] Jindal A, Jagdish RK.Sarcopenia: ammonia metabolism and hepatic encephalopathy[J].Clin Mol Hepatol, 2019, 25(3):270-279.