Xiao H J, Zhang M, Qi Y M, Han T
Third Centre Clinical College, Tianjin Medical University, Tianjin 300170, China; Department of Nutrition, Third Central Hospital of Tianjin Affiliated to Nankai University, Tianjin 300170, China.
Third Centre Clinical College, Tianjin Medical University, Tianjin 300170, China; Department of Gastroenterology and Hepatology, Third Central Hospital of Tianjin Affiliated to Nankai University, Tianjin 300170, China; Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, China; Tianjin Key Laboratory of Artificial Cell, Tianjin 300170, China.
Zhonghua Gan Zang Bing Za Zhi. 2019 Jul 20;27(7):563-566. doi: 10.3760/cma.j.issn.1007-3418.2019.07.018.
Sarcopenia is the main constituent of malnutrition and is a frequent complication of chronic liver diseases, which affects up to 70% of patients with advanced liver diseases. It has been associated with adverse clinical outcomes and prognosis, including poor quality of life, development of other complications and reduction in survival rate of non-transplant patients and transplant recipients. Chronic liver disease causes alteration in glucose metabolism, lipid oxidation, ketogenesis and protein catabolism, leading to the loss of adipose and muscle tissue. In addition, inadequate nutrients intake and limited or lack of physical activity perpetuate the reduction of muscle mass. Recently, the roles and mechanisms of muscle growth-related hormones, hyperammonemia-mediated signaling pathways and gut microbiota have been recognized. In view of its impact in chronic liver disease, sarcopenia can be considered as a powerful prognostic factor and a useful additional tool in the global assessment of patients with advanced liver disease. Rational nutritional intervention, appropriate physical exercise, effective ammonia lowering strategies, hormone supplements and targeted molecular therapy (use of myostatin blockers), and liver transplantation, may improve sarcopenia, but still needs more studies for validation.
肌肉减少症是营养不良的主要组成部分，是慢性肝病的常见并发症，影响高达70%的晚期肝病患者。它与不良临床结局和预后相关，包括生活质量差、其他并发症的发生以及非移植患者和移植受者生存率的降低。慢性肝病会导致葡萄糖代谢、脂质氧化、生酮作用和蛋白质分解代谢的改变，导致脂肪和肌肉组织流失。此外，营养摄入不足以及体力活动受限或缺乏会使肌肉量持续减少。最近，与肌肉生长相关的激素、高氨血症介导的信号通路和肠道微生物群的作用及机制已得到认可。鉴于其对慢性肝病的影响，肌肉减少症可被视为一个强有力的预后因素，也是晚期肝病患者整体评估中一个有用的附加工具。合理的营养干预、适当的体育锻炼、有效的降氨策略、激素补充和靶向分子治疗（使用肌肉生长抑制素阻滞剂）以及肝移植，可能会改善肌肉减少症，但仍需要更多研究来验证。
