Nishikawa Hiroki, Yuri Yukihisa, Enomoto Hirayuki, Ishii Akio, Iwata Yoshinori, Miyamoto Yuho, Ishii Noriko, Hasegawa Kunihiro, Nakano Chikage, Nishimura Takashi, Yoh Kazunori, Aizawa Nobuhiro, Sakai Yoshiyuki, Ikeda Naoto, Takashima Tomoyuki, Takata Ryo, Iijima Hiroko, Nishiguchi Shuhei
Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Medicine (Baltimore). 2017 May;96(19):e6868. doi: 10.1097/MD.0000000000006868.
We aimed to investigate the impact of decrease of muscle mass on survival after eradication of esophageal varices (EVs) treated by endoscopic therapies as a primary prophylaxis in patients with liver cirrhosis (LC). In all, 177 LC individuals with EVs undergoing endoscopic therapies were analyzed. We retrospectively examined the impact of muscle mass decrease as determined by psoas muscle mass (PMM) at the third lumber on computed tomography (depletion of PMM [DPMM]) on survival as compared with serum sodium combined Model for End-stage Liver Disease (MELD-Na). In comparison of the effects of these parameters, we used time-dependent receiver-operating characteristics (ROC) analysis. We also investigated parameters related to overall survival in the univariate and multivariate analyses. This study included 116 males and 61 females with a median age of 66 years. The median follow-up periods were 2.7 years (range 0.1-9.6 years). In all, 110 patients (62.1%) had DPMM. The median MELD-Na score was 7.200 (range -3.451 to 30.558). The MELD-Na score in patients with DPMM (median 7.685) was significantly higher than that in patients without DPMM (median 6.235) (P = .0212). In the multivariate analysis, presence of hepatocellular carcinoma (P < .0001), presence of DPMM (P < .0001), and MELD-Na ≥7.2 (P = .0438) were revealed to be significant predictors related to overall survival. In time-dependent ROC analyses, all area under the ROCs for DPMM in each time point were higher than those for MELD-Na in the entire cohort and in patients without hepatocellular carcinoma at baseline (n = 133). In conclusion, for LC patients treated by endoscopic therapies for EVs, DPMM had stronger prognostic impact than MELD-Na.
我们旨在研究肌肉量减少对肝硬化（LC）患者经内镜治疗作为一级预防根除食管静脉曲张（EVs）后生存的影响。总共分析了177例接受内镜治疗的LC合并EVs患者。我们回顾性研究了通过计算机断层扫描测定的第三腰椎腰大肌质量（PMM）所确定的肌肉量减少（PMM耗竭[DPMM]）与血清钠联合终末期肝病模型（MELD-Na）相比对生存的影响。在比较这些参数的作用时，我们使用了时间依赖性受试者工作特征（ROC）分析。我们还在单变量和多变量分析中研究了与总生存相关的参数。本研究包括116例男性和61例女性，中位年龄为66岁。中位随访期为2.7年（范围0.1 - 9.6年）。总共110例患者（62.1%）存在DPMM。MELD-Na评分中位数为7.200（范围 - 3.451至30.558）。存在DPMM的患者的MELD-Na评分中位数（7.685）显著高于无DPMM的患者（中位数6.235）（P = 0.0212）。在多变量分析中，肝细胞癌的存在（P < 0.0001）、DPMM的存在（P < 0.0001）以及MELD-Na≥7.2（P = 0.0438）被发现是与总生存相关的显著预测因素。在时间依赖性ROC分析中，每个时间点DPMM的ROC曲线下面积在整个队列以及基线时无肝细胞癌的患者（n = 133）中均高于MELD-Na的ROC曲线下面积。总之，对于接受内镜治疗EVs的LC患者，DPMM比MELD-Na具有更强的预后影响。
