Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
J Korean Med Sci. 2018 Oct 31;33(50):e299. doi: 10.3346/jkms.2018.33.e299. eCollection 2018 Dec 10.
Sarcopenia is associated with a poor prognosis in patients with liver cirrhosis. However, it is not known whether the rate of skeletal muscle depletion is also associated with a poor prognosis. We investigated the prognostic impact of the rate of skeletal muscle depletion in patients with liver cirrhosis.
We included retrospectively all patients with liver cirrhosis who underwent both multiple computed tomography scans and hepatic venous pressure gradient (HVPG) measurements.
A total of 131 patients with liver cirrhosis were enrolled. The mean age of the patients was 53.7 years and alcoholic liver disease was the most common cause (61.8%). Sixty-four patients (48.9%) were diagnosed with sarcopenia. The median changes in skeletal muscle area per year (ΔSMA/y) were -0.89%. During a median follow-up period of 46.2 months (range, 3.4-87.6), 45 patients (34.4%) died. In multivariate analyses, age, Child-Pugh score, HVPG, presence of sarcopenia and ΔSMA/y were independently associated with mortality. Cumulative mortality was significantly higher in patients with ΔSMA/y < -2.4% than those with ΔSMA/y ≥ -2.4% (log-rank test, < 0.001).
Both the presence and rate of change of sarcopenia are independently associated with long-term mortality in patients with liver cirrhosis.
肌肉减少症与肝硬化患者的预后不良相关。然而，骨骼肌耗竭的速度是否也与预后不良相关尚不清楚。我们研究了肝硬化患者骨骼肌耗竭速度对预后的影响。
我们回顾性纳入了所有接受多次 CT 扫描和肝静脉压力梯度（HVPG）测量的肝硬化患者。
共纳入 131 例肝硬化患者，患者的平均年龄为 53.7 岁，最常见的病因是酒精性肝病（61.8%）。64 例（48.9%）患者被诊断为肌肉减少症。骨骼肌面积每年的变化中位数（ΔSMA/y）为-0.89%。在中位随访时间为 46.2 个月（范围 3.4-87.6）期间，45 例患者（34.4%）死亡。多变量分析显示，年龄、Child-Pugh 评分、HVPG、肌肉减少症的存在和ΔSMA/y 与死亡率独立相关。ΔSMA/y < -2.4%的患者累积死亡率明显高于ΔSMA/y ≥ -2.4%的患者（对数秩检验， < 0.001）。
肌肉减少症的存在和变化速度均与肝硬化患者的长期死亡率独立相关。
