Montano-Loza Aldo J
Aldo J Montano-Loza, Division of Gastroenterology and Liver Unit, University of Alberta Hospital, University of Alberta, Edmonton AB T6G 2X8, Canada.
World J Gastroenterol. 2014 Jul 7;20(25):8061-71. doi: 10.3748/wjg.v20.i25.8061.
The most commonly recognized complications in cirrhotic patients include ascites, hepatic encephalopathy, variceal bleeding, susceptibility for infections, kidney dysfunction, and hepatocellular carcinoma; however, severe muscle wasting or sarcopenia are the most common and frequently unseen complications which negatively impact survival, quality of life, and response to stressor, such as infections and surgeries. At present, D'Amico stage classification, Child-Pugh, and MELD scores constitute the best tools to predict mortality in patients with cirrhosis; however, one of their main limitations is the lack of assessing the nutritional and functional status. Currently, numerous methods are available to evaluate the nutrition status of the cirrhotic patient; nevertheless, most of these techniques have limitations primarily because lack of objectivity, reproducibility, and prognosis discrimination. In this regard, an objective and reproducible technique, such as muscle mass quantification with cross-sectional imaging studies (computed tomography scan or magnetic resonance imaging) constitute an attractive index of nutritional status in cirrhosis. Sarcopenia is part of the frailty complex present in cirrhotic patients, resulting from cumulative declines across multiple physiologic systems and characterized by impaired functional capacity, decreased reserve, resistance to stressors, and predisposition to poor outcomes. In this review, we discuss the current accepted and new methods to evaluate prognosis in cirrhosis. Also, we analyze the current knowledge regarding incidence and clinical impact of malnutrition and sarcopenia in patients with cirrhosis and their impact after liver transplantation. Finally, we discuss existing and potential novel therapeutic approaches for malnutrition in cirrhosis, emphasizing the recognition of sarcopenia in an effort to reduced morbidity related and improved survival in cirrhosis.
肝硬化患者最常见的并发症包括腹水、肝性脑病、静脉曲张出血、感染易感性、肾功能障碍和肝细胞癌；然而，严重的肌肉萎缩或肌肉减少症是最常见且常常被忽视的并发症，会对生存、生活质量以及对感染和手术等应激源的反应产生负面影响。目前，达米科分期分类、Child-Pugh评分和终末期肝病模型（MELD）评分是预测肝硬化患者死亡率的最佳工具；然而，它们的主要局限性之一是缺乏对营养和功能状态的评估。目前，有多种方法可用于评估肝硬化患者的营养状况；然而，这些技术大多存在局限性，主要是因为缺乏客观性、可重复性和预后判别能力。在这方面，一种客观且可重复的技术，如通过横断面成像研究（计算机断层扫描或磁共振成像）定量肌肉量，是肝硬化患者营养状况的一个有吸引力的指标。肌肉减少症是肝硬化患者虚弱综合征的一部分，是多个生理系统累积衰退的结果，其特征是功能能力受损、储备减少、对压力源的抵抗力下降以及易发生不良后果。在这篇综述中，我们讨论了目前公认的和新的评估肝硬化预后的方法。此外，我们分析了关于肝硬化患者营养不良和肌肉减少症的发生率及其临床影响以及肝移植后影响的现有知识。最后，我们讨论了肝硬化患者营养不良现有的和潜在的新治疗方法，强调对肌肉减少症的认识，以努力降低肝硬化相关的发病率并提高生存率。
