Hiraoka Atsushi, Tamura Rumi, Oka Misato, Izumoto Hirofumi, Ueki Hidetaro, Tsuruta Miho, Yoshino Takeaki, Ono Atsushi, Aibiki Toshihiko, Okudaira Tomonari, Yamago Hiroka, Suga Yoshifumi, Iwasaki Ryuichiro, Mori Kenichiro, Miyata Hideki, Tsubouchi Eiji, Kishida Masato, Ninomiya Tomoyuki, Hirooka Masashi, Abe Masanori, Matsuura Bunzo, Hiasa Yoichi, Kino Tsutae, Yamamoto Kayo, Michitaka Kojiro
Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Department of Nursing, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Hepatol Res. 2019 Jul;49(7):823-829. doi: 10.1111/hepr.13322. Epub 2019 Mar 19.
Falling is known to be associated with cognitive function. We evaluated the relationship between muscle function and falls in patients with chronic liver disease (CLD).
We enrolled 100 sequential CLD patients without dementia who were admitted to our institution for scheduled treatment from July 2017 to May 2018 (age 71.0 ± 10.2 years; 76 men). All subjects were self-reliant in regard to activities of daily living. On admission, handgrip strength was determined and falls within 1 month of admission were noted. For determining handgrip strength decline (HSD), previously reported values were used (men, <26 kg; women, <18 kg). The relationship between HSD and falls in CLD patients was evaluated in a retrospective manner.
Thirty-two patients had chronic hepatitis and 49 had liver cirrhosis (LC) Child-Pugh A, 17 had LC Child-Pugh B, and 2 had LC Child-Pugh C. Twelve (12.0%) had a history of falling, including 8 (26.7%) of 30 with and 4 (5.7%) of 70 without HSD (P = 0.006). The cut-off value for age in relationship to falling was 69.0 years old (area under the receiver operating characteristic curve, 0.668; 95% confidence interval, 0.514-0.821). A fall during hospitalization was noted more often in patients with a history of falling than in those without (16.7% [2/12] vs. 2.3% [2/88], P = 0.018).
In CLD patients, the presence of HSD and older age might be independent risk factors for predicting a fall. Assessment of handgrip strength could be an effective clinical tool for easily assessing the risk of falling, especially in elderly CLD patients.
已知跌倒与认知功能相关。我们评估了慢性肝病（CLD）患者肌肉功能与跌倒之间的关系。
我们纳入了2017年7月至2018年5月期间因计划治疗入住我院的100例无痴呆的连续性CLD患者（年龄71.0±10.2岁；男性76例）。所有受试者在日常生活活动方面均能自理。入院时测定握力，并记录入院后1个月内的跌倒情况。为确定握力下降（HSD），采用先前报道的值（男性，<26 kg；女性，<18 kg）。以回顾性方式评估CLD患者中HSD与跌倒之间的关系。
32例患者患有慢性肝炎，49例患有肝硬化（LC）Child-Pugh A级，17例患有LC Child-Pugh B级，2例患有LC Child-Pugh C级。12例（12.0%）有跌倒史，其中30例有HSD者中有8例（26.7%），70例无HSD者中有4例（5.7%）（P = 0.006）。与跌倒相关的年龄截断值为６９.０岁（受试者工作特征曲线下面积，0.668；95%置信区间，0.514 - 0.821）。有跌倒史的患者住院期间跌倒的发生率高于无跌倒史者（16.7% [2/12] 对 2.3% [2/88]，P = 0.018）。
在CLD患者中，HSD的存在和年龄较大可能是预测跌倒的独立危险因素。握力评估可能是一种有效的临床工具，可轻松评估跌倒风险，尤其是在老年CLD患者中。
