Sakai Yoshiyuki, Nishikawa Hiroki, Enomoto Hirayuki, Yoh Kazunori, Ishii Akio, Iwata Yoshinori, Miyamoto Yuho, Ishii Noriko, Yuri Yukihisa, Hasegawa Kunihiro, Nakano Chikage, Nishimura Takashi, Aizawa Nobuhiro, 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 Jun;96(26):e7377. doi: 10.1097/MD.0000000000007377.
To the best of our knowledge, no available data with regard to changes in skeletal muscle mass for liver cirrhosis (LC) patients with esophageal varices (EVs) undergoing endoscopic therapy as a primary prophylaxis could exist. As endoscopic therapies, such as endoscopic injection sclerotherapy or endoscopic band ligation for EVs, accompany invasive procedure and patients with EVs receiving endoscopic therapies mostly rest in bed during hospitalization, clarifying these issues are clinically of importance. The purposes of this study were therefore to examine changes in skeletal muscle mass for LC patients with EVs undergoing endoscopic therapy as a primary prophylaxis and to identify pretreatment predictors which are associated with the amelioration in skeletal muscle mass. This is a subgroup analysis in our previous randomized controlled trial. A total of 51 LC patients with EVs were analyzed. Skeletal muscle mass was assessed using bioimpedance analysis (BIA). Skeletal muscle index (SMI) was defined as sum of skeletal muscle mass in body trunk and upper and lower extremities divided by height squared (cm/m) using data for BIA. We compared the changes in SMI at baseline and SMI at Day 50 after endoscopic treatment for EVs. Our study cohort included 33 males and 18 females with median (range) age of 62 (29-81) years. There were 31 patients with Child-Pugh A and 20 with Child-Pugh B. The median SMI for the entire cohort at baseline was 8.96 cm/m (range, 5.87-13.11 cm/m), while the median SMI for the entire cohort at Day 50 was 8.83 cm/m (range, 5.59-12.29 cm/m) (P = .9995). In baseline characteristics, prealbumin (P = .0477), branched-chain amino acid to tyrosine ratio (BTR) (P = .0056), and retinol-binding protein (P = .0296) in the increased SMI group (n = 15) were significantly higher than those in the nonincreased SMI group (n = 36). Multivariate analysis for the above 3 significant factors showed that only BTR was a significant prognostic pretreatment factor linked to the presence of increased SMI (P = .0235). In conclusion, pretreatment BTR level can be helpful for predicting increased SMI after endoscopic therapy as a primary prophylaxis for LC patients with EVs.
据我们所知，目前可能不存在关于接受内镜治疗作为一级预防的肝硬化（LC）合并食管静脉曲张（EVs）患者骨骼肌质量变化的可用数据。由于内镜治疗，如内镜下注射硬化剂或内镜下套扎术治疗EVs，伴随着侵入性操作，且接受内镜治疗的EVs患者在住院期间大多卧床休息，因此阐明这些问题在临床上具有重要意义。因此，本研究的目的是检查接受内镜治疗作为一级预防的LC合并EVs患者的骨骼肌质量变化，并确定与骨骼肌质量改善相关的预处理预测因素。这是我们之前随机对照试验的亚组分析。共分析了51例LC合并EVs患者。使用生物电阻抗分析（BIA）评估骨骼肌质量。骨骼肌指数（SMI）定义为使用BIA数据，将躯干、上肢和下肢的骨骼肌质量总和除以身高的平方（cm/m²）。我们比较了内镜治疗EVs后第50天的SMI与基线时的SMI变化。我们的研究队列包括33名男性和18名女性，中位（范围）年龄为62（29 - 81）岁。有31例Child-Pugh A级患者和20例Child-Pugh B级患者。整个队列在基线时的中位SMI为8.96 cm/m²（范围，5.87 - 13.11 cm/m²），而在第50天时整个队列的中位SMI为8.83 cm/m²（范围，5.59 - 12.29 cm/m²）（P = 0.9995）。在基线特征方面，骨骼肌质量增加组（n = 15）的前白蛋白（P = 0.0477）、支链氨基酸与酪氨酸比值（BTR）（P = 0.0056）和视黄醇结合蛋白（P = 0.0296）显著高于骨骼肌质量未增加组（n = 36）。对上述3个显著因素进行多变量分析显示，只有BTR是与骨骼肌质量增加相关的显著预后预处理因素（P = 0.0235）。总之，预处理BTR水平有助于预测接受内镜治疗作为一级预防的LC合并EVs患者骨骼肌质量的增加。
