Xiao H J, Ye Q, Zhang M, Qi Y M, Han T, Wang X
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.
Department of Gastroenterology and Hepatology, Third Central Hospital of Tianjin Affiliated to Nankai University, Tianjin 300170, China.
Zhonghua Gan Zang Bing Za Zhi. 2020 Jan 20;28(1):53-57. doi: 10.3760/cma.j.issn.1007-3418.2020.01.013.
To study the occurrence of sarcopenia in patients with liver cirrhosis, and to explore their risk factors and impact on clinical outcomes. 199 hospitalized cases with liver cirrhosis were collected for nutritional risk screening, anthropometric measurement and blood biochemical examination. The body composition analysis was measured based on the skeletal muscle content of the four limbs to calculate the appendicular skeletal muscle mass index (ASMI). Patients were divided into sarcopenia and non-sarcopenia group and the relevant indexes of both groups were compared to screen for factors affecting the occurrence of sarcopenia. During the follow-up of 48 months, the survival and complications of the both groups were compared. Statistical analysis was performed using t-test, χ(2) test and logistic regression analysis in terms of different data. The incidence of sarcopenia in cirrhosis was 36.7%, with the highest prevalence in patients with recurrent hepatic encephalopathy (62.5%), followed by patients with abdominal ascites / pleural effusion (37.6%). The incidence of sarcopenia was significantly higher in those with nutritional risk than in those without nutritional risk ( < 0.05). However, even among those without nutritional risk, 14.8% had combined sarcopenia. The body mass index (BMI), upper arm muscle circumference (AMC), and body cell mass (BCM) of the sarcopenia group were lower than those of the non-sarcopenia group ( < 0.05), and the edema index (ECW/TBW) was higher than the latter ( < 0.05). Multivariate analysis showed that age, gender, BMI, and complications of hepatic encephalopathy were the main influencing factors of cirrhosis combined with sarcopenia ( < 0.05). During the follow-up period, the sarcopenia group had a higher mortality rate than non-sarcopenia goup ( < 0.05), and the incidence of recurrent abdominal ascites/pleural effusion, hepatic encephalopathy, and infection was also significantly elevated ( < 0.05). Sarcopenia is one of the manifestations of malnutrition in patients with liver cirrhosis, which increases the risk of mortality and other complications, and has adverse impact on the clinical outcome. Additionally, older age, male sex, low BMI and recurrent hepatic encephalopathy has higher risk for developing sarcopenia.
研究肝硬化患者肌肉减少症的发生情况，探讨其危险因素及对临床结局的影响。收集199例住院肝硬化患者进行营养风险筛查、人体测量及血液生化检查。基于四肢骨骼肌含量进行身体成分分析，计算四肢骨骼肌质量指数（ASMI）。将患者分为肌肉减少症组和非肌肉减少症组，比较两组相关指标，筛查影响肌肉减少症发生的因素。在48个月的随访期间，比较两组的生存情况及并发症。根据不同数据采用t检验、χ²检验和逻辑回归分析进行统计学分析。肝硬化患者肌肉减少症的发生率为36.7%，其中反复发生肝性脑病的患者患病率最高（62.5%），其次是腹水/胸腔积液患者（37.6%）。有营养风险者肌肉减少症的发生率显著高于无营养风险者（P<0.05）。然而，即使在无营养风险者中，也有14.8%合并肌肉减少症。肌肉减少症组的体重指数（BMI）、上臂肌肉周长（AMC）和身体细胞量（BCM）均低于非肌肉减少症组（P<0.05），而水肿指数（ECW/TBW）高于后者（P<0.05）。多因素分析显示，年龄、性别、BMI和肝性脑病并发症是肝硬化合并肌肉减少症的主要影响因素（P<0.05）。随访期间，肌肉减少症组的死亡率高于非肌肉减少症组（P<0.05），反复发生腹水/胸腔积液、肝性脑病和感染的发生率也显著升高（P<0.05）。肌肉减少症是肝硬化患者营养不良的表现之一，增加了死亡风险和其他并发症的发生风险，对临床结局有不利影响。此外，年龄较大、男性、低BMI和反复发生肝性脑病者发生肌肉减少症的风险较高。
