肌肉减少症与代谢不健康的慢性乙型肝炎患者发生显著肝纤维化的风险相关。

Sarcopenia is associated with the risk of significant liver fibrosis in metabolically unhealthy subjects with chronic hepatitis B.

机构信息

Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Aliment Pharmacol Ther. 2018 Aug;48(3):300-312. doi: 10.1111/apt.14843. Epub 2018 Jun 19.

DOI:10.1111/apt.14843

PMID:29920701

Abstract

BACKGROUND

Sarcopenia is significantly associated with the degree of liver fibrosis. This study investigated the influence of sarcopenia on liver fibrosis in individuals with chronic hepatitis B.

METHODS

Data from the Korean National Health and Nutrition Examination Surveys 2008-2011 were analysed. The sarcopenia index (total appendicular skeletal muscle mass [kg]/body mass index [kg/m ]) was calculated using dual-energy X-ray absorptiometry. Sarcopenia was defined as the lowest quintile sarcopenia index value (cut-offs: 0.89 for men and 0.58 for women). The fibrotic burden was assessed using the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index. Significant fibrosis was defined as the highest nonalcoholic fatty liver disease fibrosis score quartile and a fibrosis-4 index ≥2.67.

RESULTS

Among the 506 respondents with chronic hepatitis B (258 men and 248 women), the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index identified sarcopenia and significant fibrosis in 126 (24.9%) and 217 (42.9%), respectively. Sarcopenia was significantly associated with significant fibrosis, regardless of the fibrosis prediction model used (all P < 0.05). When the study population was stratified according to metabolic factors, sarcopenia was specifically associated with an increased risk of significant fibrosis among subgroups with obesity, insulin resistance, metabolic syndrome and liver steatosis (odds ratio 2.37-3.57; all P < 0.05). An independent association between sarcopenia and significant fibrosis was identified after adjusting for other confounders (odds ratio 2.67-3.62 by the nonalcoholic fatty liver disease fibrosis score and 2.04-2.62 by the fibrosis-4 index; all P < 0.05).

CONCLUSIONS

Sarcopenia is associated with significant fibrosis in subjects with chronic hepatitis B, specifically those with obesity, insulin resistance, metabolic syndrome and liver steatosis.

摘要

背景

肌少症与肝纤维化程度显著相关。本研究旨在探讨肌少症对慢性乙型肝炎患者肝纤维化的影响。

方法

本研究分析了 2008-2011 年韩国国家健康和营养调查的数据。通过双能 X 射线吸收法计算肌少症指数（四肢骨骼肌质量[kg]/体重指数[kg/m ]）。肌少症定义为最低五分位肌少症指数值（男性截断值：0.89；女性截断值：0.58）。采用非酒精性脂肪性肝病纤维化评分和纤维化-4 指数评估肝纤维化负担。显著纤维化定义为非酒精性脂肪性肝病纤维化评分最高四分位数和纤维化-4 指数≥2.67。

结果

在 506 名患有慢性乙型肝炎的受访者中（男性 258 名，女性 248 名），非酒精性脂肪性肝病纤维化评分和纤维化-4 指数分别在 126 名（24.9%）和 217 名（42.9%）患者中识别出肌少症和显著纤维化。无论使用哪种纤维化预测模型，肌少症均与显著纤维化显著相关（均 P<0.05）。当根据代谢因素对研究人群进行分层时，肌少症与肥胖、胰岛素抵抗、代谢综合征和肝脂肪变性亚组中显著纤维化的风险增加相关（比值比 2.37-3.57；均 P<0.05）。在调整其他混杂因素后，肌少症与显著纤维化之间仍存在独立关联（非酒精性脂肪性肝病纤维化评分的比值比为 2.67-3.62，纤维化-4 指数的比值比为 2.04-2.62；均 P<0.05）。