Departments of Gastroenterology, Hepatology and Pathobiology, Cleveland Clinic, Cleveland, Ohio, USA.
Eur J Gastroenterol Hepatol. 2013 Jan;25(1):85-93. doi: 10.1097/MEG.0b013e328359a759.
Sarcopenia is the most frequent complication of cirrhosis. A transjugular intrahepatic portosystemic stent (TIPS) lowers portal pressure in cirrhosis and alters the body composition. Changes in the skeletal muscle area and adipose tissue volume were quantified by computed tomography (CT) before and after TIPS.
Fifty-seven consecutive cirrhotics who had a CT scan before and after TIPS were studied. Simultaneous age-matched, sex-matched, Child's score-matched, and Model for End-Stage Liver Disease score-matched cirrhotics (n=32) who did not undergo TIPS comprised the disease control and 57 healthy individuals who had undergone CT abdomen comprised the healthy control population. Muscle area and fat volume were obtained at the mid-L4 vertebra level on the CT scans.
Patients (mean age 55.5±8.1 years) were followed up for a mean of 13.5±11.9 months following TIPS. Total psoas and paraspinal muscle area increased significantly (P<0.0001) after TIPS (from 22.8±0.9 to 25.1±0.9 cm and 54.5±1.3 to 57.9±1.5 cm, respectively). After TIPS, muscle area increased in 41 patients but remained unchanged or decreased in 16 patients. Post-TIPS visceral fat volume decreased significantly (47.7±4.1 to 40.5±3.4 cm; P<0.001). Failure to reverse sarcopenia after TIPS was accompanied by higher (P=0.007) mortality (43.5%) compared with patients in whom the total muscle area increased (9.8%). On multivariate analysis, predictors of reversal of sarcopenia after TIPS included male sex and lower pre-TIPS muscle area. Cirrhotic patients who did not undergo TIPS showed no change in the mean muscle area over 13.1±1.3 months.
TIPS reverses sarcopenia in cirrhotic patients. Failure to improve muscle area after TIPS was accompanied by a higher mortality.
肌肉减少症是肝硬化最常见的并发症。经颈静脉肝内门体分流术 (TIPS) 可降低肝硬化患者的门静脉压力并改变身体成分。通过 CT 扫描在 TIPS 前后量化骨骼肌面积和脂肪组织体积的变化。
对 57 例接受 TIPS 前后进行 CT 扫描的连续肝硬化患者进行了研究。同时进行年龄匹配、性别匹配、Child 评分匹配和终末期肝病模型评分匹配（n=32）未接受 TIPS 的肝硬化患者和 57 例接受 CT 腹部检查的健康个体作为健康对照组。在 CT 扫描的 L4 椎体中部获得肌肉面积和脂肪体积。
患者（平均年龄 55.5±8.1 岁）在 TIPS 后平均随访 13.5±11.9 个月。TIPS 后，总腰大肌和腰背肌面积显著增加（P<0.0001）（分别从 22.8±0.9cm 增加到 25.1±0.9cm 和从 54.5±1.3cm 增加到 57.9±1.5cm）。TIPS 后，41 例患者的肌肉面积增加，16 例患者的肌肉面积保持不变或减少。TIPS 后内脏脂肪体积显著减少（从 47.7±4.1cm 减少到 40.5±3.4cm；P<0.001）。TIPS 后肌肉减少症无法逆转的患者死亡率较高（43.5%），与肌肉总面积增加的患者（9.8%）相比（P=0.007）。多变量分析显示，TIPS 后肌肉减少症逆转的预测因素包括男性和较低的 TIPS 前肌肉面积。未接受 TIPS 的肝硬化患者在 13.1±1.3 个月内肌肉面积无变化。
TIPS 可逆转肝硬化患者的肌肉减少症。TIPS 后肌肉面积未改善与死亡率升高有关。
