Department of Gastroenterology, Komaki City Hospital, Komaki, Aichi, Japan.
Nutrition support team, Komaki City Hospital, Komaki, Aichi, Japan.
Nutrition. 2018 Oct;54:83-88. doi: 10.1016/j.nut.2018.03.011. Epub 2018 Mar 21.
The effect of skeletal muscle fat deposition on the prognosis of patients with chronic liver disease remains unclear. Skeletal muscle fat deposition can be estimated by attenuation of skeletal muscle in Hounsfield units (HU) on computed tomography (CT). The aim of this retrospective cohort study was to investigate the association between skeletal muscle fat deposition assessed by skeletal muscle attenuation (SMA), and hepatocellular carcinoma (HCC).
We enrolled 288 patients with chronic liver disease (139 men, 149 women; mean age 67.5 ± 10.4 y; hepatitis C virus, 239; hepatitis B virus, 17; without viral infection, 32; chronic hepatitis, 227; and cirrhosis, 61) who underwent liver biopsy and CT scanning between January 2013 and February 2017. The patients were divided into two groups based on SMA levels, with the cutoff value of 31 HU. We analyzed the effect of SMA on HCC development.
During the study follow-up period (median, 2.50 y; range, 0.5-4.7 y), HCC was identified in 19 patients (7%). The cumulative incidence of HCC in patients with lower SMA (<31 HU) was significantly higher than in patients with SMA ≥31 HU (P = 0.007). Cox proportional hazards regression analysis confirmed cirrhosis (hazard ratio [HR], 6.626; 95% confidence interval [CI], 2.57-17.12; P <0.001) and lower SMA (HR, 3.502; 95% CI, 1.25-9.83; P = 0.017) as significant independent factors associated with HCC development in patients with chronic liver disease.
Patients with cirrhosis and skeletal muscle fat deposition assessed by SMA had a higher risk for developing HCC.
骨骼肌脂肪沉积对慢性肝病患者预后的影响尚不清楚。骨骼肌脂肪沉积可以通过 CT 上骨骼肌的衰减（Hounsfield 单位，HU）来估计。本回顾性队列研究的目的是探讨骨骼肌衰减（SMA）评估的骨骼肌脂肪沉积与肝细胞癌（HCC）之间的关系。
我们纳入了 288 名慢性肝病患者（男性 139 名，女性 149 名；平均年龄 67.5±10.4 岁；丙型肝炎病毒 239 名，乙型肝炎病毒 17 名，无病毒感染 32 名，慢性肝炎 227 名，肝硬化 61 名），他们在 2013 年 1 月至 2017 年 2 月期间接受了肝活检和 CT 扫描。根据 SMA 水平将患者分为两组，以 31 HU 为截断值。我们分析了 SMA 对 HCC 发展的影响。
在研究随访期间（中位数 2.50 年；范围 0.5-4.7 年），19 名患者（7%）被诊断为 HCC。SMA 较低（<31 HU）的患者 HCC 累积发生率明显高于 SMA≥31 HU 的患者（P=0.007）。Cox 比例风险回归分析证实肝硬化（危险比 [HR]，6.626；95%置信区间 [CI]，2.57-17.12；P<0.001）和 SMA 较低（HR，3.502；95% CI，1.25-9.83；P=0.017）是慢性肝病患者 HCC 发展的独立危险因素。
患有肝硬化和 SMA 评估的骨骼肌脂肪沉积的患者发生 HCC 的风险更高。
