Nishikawa Hiroki, Enomoto Hirayuki, Ishii Akio, Iwata Yoshinori, Miyamoto Yuho, Ishii Noriko, Yuri Yukihisa, Takata Ryo, Hasegawa Kunihiro, Nakano Chikage, Nishimura Takashi, Yoh Kazunori, Aizawa Nobuhiro, Sakai Yoshiyuki, Ikeda Naoto, Takashima Tomoyuki, Iijima Hiroko, Nishiguchi Shuhei
Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Hepatol Res. 2017 Nov;47(12):1223-1234. doi: 10.1111/hepr.12857. Epub 2017 Jan 27.
To develop and validate a simple predictive model using easily obtained clinical parameters to predict decreased skeletal muscle mass (DSMM) in chronic liver disease (CLD) patients (n = 652).
Study subjects were divided into a training set (n = 326) and a validation set (n = 326). Decreased skeletal muscle mass was diagnosed based on skeletal muscle mass index measured by bioimpedance analysis. Variables significantly associated with DSMM were identified using univariate and multivariate analyses in the training set and used to construct a predictive formula. Receiver operating characteristic (ROC) curve analysis was carried out and the predictive model was validated in the validation set. Subgroup analyses were undertaken based on gender, age, or cirrhosis status of patients.
Body mass index (BMI), age, serum albumin, and branched-chain amino acid to tyrosine ratio (BTR) were determined to be significant predictive factors for DSMM. A composite formula "BALB score" was constructed [-7.740 + (0.539 × BMI) + (-0.112 × age) + (1.358 × albumin) + (-0.264 × BTR)]. The BALB score had the best predictive characteristics among all variables in both population sets (area under the ROC curve, 0.877-0.898). Patients with DSMM were stratified into three BALB score categories (>4, 0-4, and <0). Subgroup analyses also showed that BALB scoring was predictive of DSMM irrespective of gender, age, or cirrhosis status. The BALB score significantly correlated with psoas muscle index on computed tomography (r = 0.6083 for men; r = 0.6814 for women).
The BALB scoring system based on routinely used clinical parameters offers a convenient and non-invasive method for predicting DSMM in compensated CLD patients with high accuracy.
利用易于获取的临床参数开发并验证一个简单的预测模型，以预测慢性肝病（CLD）患者（n = 652）的骨骼肌量减少（DSMM）情况。
研究对象被分为训练集（n = 326）和验证集（n = 326）。基于生物电阻抗分析测量的骨骼肌量指数诊断骨骼肌量减少。在训练集中通过单因素和多因素分析确定与DSMM显著相关的变量，并用于构建预测公式。进行受试者工作特征（ROC）曲线分析，并在验证集中验证预测模型。根据患者的性别、年龄或肝硬化状态进行亚组分析。
体重指数（BMI）、年龄、血清白蛋白和支链氨基酸与酪氨酸比值（BTR）被确定为DSMM的显著预测因素。构建了一个复合公式“BALB评分”[-7.740 +（0.539×BMI）+（-0.112×年龄）+（1.358×白蛋白）+（-0.264×BTR）]。在两个总体集中，BALB评分在所有变量中具有最佳预测特征（ROC曲线下面积，0.877 - 0.898）。DSMM患者被分为三个BALB评分类别（>4、0 - 4和<0）。亚组分析还表明，无论性别、年龄或肝硬化状态如何，BALB评分都可预测DSMM。BALB评分与计算机断层扫描上的腰大肌指数显著相关（男性r = 0.6083；女性r = 0.6814）。
基于常规使用的临床参数的BALB评分系统为准确预测代偿期CLD患者的DSMM提供了一种方便且无创的方法。
