Hanai Tatsunori, Shiraki Makoto, Miwa Takao, Watanabe Satoshi, Imai Kenji, Suetsugu Atsushi, Takai Koji, Moriwaki Hisataka, Shimizu Masahito
Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Gifu, Japan.
Hepatol Res. 2019 Jan;49(1):82-95. doi: 10.1111/hepr.13244. Epub 2018 Sep 25.
Sarcopenia, the loss of skeletal muscle mass, impairs prognosis of patients with liver cirrhosis. The aim of this study was to investigate the effect of loop diuretics, which are frequently used to treat hepatic edema/ascites, on skeletal muscle depletion and the prognosis in patients with liver cirrhosis.
This retrospective study evaluated 226 patients with liver cirrhosis. The skeletal muscle cross-sectional area at the level of the third lumbar vertebra was measured using computed tomography. The relative change in skeletal muscle area per year (ΔSMA) was calculated, and the association between ΔSMA and therapeutic dosage of loop diuretics was examined.
The therapeutic dosage of loop diuretics was inversely correlated with ΔSMA by simple (r = -0.27, P < 0.0001) and multiple regression analyses (t = -3.07, P = 0.002). During a median follow-up period of 49 months, 82 patients died. Overall survival rates were lower in patients treated with loop diuretics at >20 mg than in those who received ≤20 mg (median, 66 vs. 97 months; P = 0.002). Multivariate analysis revealed that loop diuretics of >20 mg (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.03-3.24; P = 0.039) and ΔSMA of ≤-3.1% (HR, 3.87; 95% CI, 2.32-6.60; P < 0.0001) were independently associated with mortality.
A higher dose of loop diuretic use was associated with more rapid skeletal muscle depletion and poor survival in patients with liver cirrhosis, independent of the severity of liver disease.
肌肉减少症，即骨骼肌质量的丧失，会损害肝硬化患者的预后。本研究的目的是调查常用于治疗肝性水肿/腹水的袢利尿剂对肝硬化患者骨骼肌消耗及预后的影响。
这项回顾性研究评估了226例肝硬化患者。使用计算机断层扫描测量第三腰椎水平的骨骼肌横截面积。计算每年骨骼肌面积的相对变化（ΔSMA），并检查ΔSMA与袢利尿剂治疗剂量之间的关联。
通过简单（r = -0.27，P < 0.0001）和多元回归分析（t = -3.07，P = 0.002），袢利尿剂的治疗剂量与ΔSMA呈负相关。在中位随访期49个月期间，82例患者死亡。使用袢利尿剂剂量>20 mg的患者的总生存率低于接受≤20 mg的患者（中位数分别为66个月和97个月；P = 0.002）。多变量分析显示，>20 mg的袢利尿剂（风险比[HR]，1.86；95%置信区间[CI]，1.03 - 3.24；P = 0.039）和ΔSMA≤ -3.1%（HR，3.87；95% CI，2.32 - 6.60；P < 0.0001）与死亡率独立相关。
更高剂量的袢利尿剂使用与肝硬化患者骨骼肌更快消耗和较差的生存率相关，与肝脏疾病的严重程度无关。
