Hiraoka Atsushi, Michitaka Kojiro, Izumoto Hirofumi, Ueki Hidetaro, Kitahata Shogo, Aibiki Toshihiko, Okudaira Tomonari, Yamago Hiroka, Miyamoto Yuji, Iwasaki Ryuichiro, Tomida Hideomi, Mori Kenichiro, Miyata Hideki, Tsubouchi Eiji, Kishida Masato, Hirooka Masashi, Abe Masanori, Matsuura Bunzo, Ninomiya Tomoyuki, Hiasa Yoichi
Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan.
Hepatol Res. 2018 Jun;48(7):502-508. doi: 10.1111/hepr.13051. Epub 2018 Feb 6.
There are few reports regarding relative changes in muscle function of patients with chronic liver disease (CLD). We examined CLD patients to evaluate relative changes in handgrip strength and muscle volume.
We enrolled 413 CLD outpatients who underwent handgrip strength measurements in both 2015 and 2017 (age 67.9 ± 10.0 years; male / female = 242/171; hepatitis C virus [HCV] / hepatitis B virus [HBV] / HBV and HCV / alcohol / others = 239/92/4/22/56; Child-Pugh score [CPS] in 2015 [5/6/7/8/9/≥10 = 335/51/12/11/3/1]). Relative change in muscle volume (ΔPI) from 2015 to 2017 was evaluated using computed tomography findings in 230 of the patients, using a previously reported method. Clinical characteristics, as well as relative changes of handgrip strength (ΔHGS) and ΔPI were analyzed.
For the patient cohort as a whole, CPS became significantly worse in 2017 (5/6/7/8/9/≥10 = 319/56/13/11/5/9; P = 0.002). In individual patients with CPS decline, serum albumin level was significantly decreased (3.78 ± 0.50 to 3.33 ± 0.61 g/dL; P < 0.001), whereas no decrease was seen in those without such a decline (4.16 ± 0.48 to 4.20 ± 0.44 g/dL; P = 0.028). Furthermore, ΔHGS (-1.4 ± 4.8 [n = 59] vs. 0.7 ± 4.8 kg [n = 354]; P = 0.002) and ΔPI (-0.44 ± 0.88 [n = 38] vs. 0.03 ± 0.64 cm /m [n = 192]; P = 0.003) were worse in patients with, compared to those without, a decline in CPS. Age was not significantly different between patients with and without handgrip strength decline (66.5 ± 10.3 vs. 65.3 ± 9.9 years; P = 0.256). There was a significant relationship between ΔHGS, ΔPI and relative change in serum albumin (r = 0.161, P = 0.001 and r = 0.225, P < 0.001, respectively).
Decline in CPS, especially decreasing serum albumin level, showed a significant relationship with muscle function reduction and muscle volume loss.
关于慢性肝病（CLD）患者肌肉功能的相对变化的报道较少。我们对CLD患者进行了检查，以评估握力和肌肉体积的相对变化。
我们纳入了413例在2015年和2017年都进行了握力测量的CLD门诊患者（年龄67.9±10.0岁；男/女=242/171；丙型肝炎病毒[HCV]/乙型肝炎病毒[HBV]/HBV和HCV/酒精/其他=239/92/4/22/56；2015年的Child-Pugh评分[CPS][5/6/7/8/9/≥10=335/51/12/11/3/1]）。使用先前报道的方法，利用230例患者的计算机断层扫描结果评估了2015年至2017年肌肉体积的相对变化（ΔPI）。分析了临床特征以及握力（ΔHGS）和ΔPI的相对变化。
对于整个患者队列，2017年CPS显著变差（5/6/7/8/9/≥10=319/56/13/11/5/9；P=0.002）。在CPS下降的个体患者中，血清白蛋白水平显著降低（3.78±0.50至3.33±0.61g/dL；P<0.001），而在没有这种下降的患者中未观察到降低（4.16±0.48至4.20±0.44g/dL；P=0.028）。此外，与CPS未下降的患者相比，CPS下降的患者的ΔHGS（-1.4±4.8[n=59]对0.7±4.8kg[n=354]；P=0.002）和ΔPI（-0.44±0.88[n=38]对0.03±0.64cm/m[n=192]；P=0.003）更差。握力下降和未下降的患者之间年龄无显著差异（66.5±10.3对65.3±9.9岁；P=0.256）。ΔHGS、ΔPI与血清白蛋白的相对变化之间存在显著关系（r=0.161，P=0.001和r=0.225，P<0.001）。
CPS下降，尤其是血清白蛋白水平降低，与肌肉功能降低和肌肉体积减少显著相关。
