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肝硬化患者肌肉减少症评估的临床影响。

Clinical impact of sarcopenia assessment in patients with liver cirrhosis.

机构信息

Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.

Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy.

出版信息

Expert Rev Gastroenterol Hepatol. 2021 Apr;15(4):377-388. doi: 10.1080/17474124.2021.1848542. Epub 2020 Nov 25.

Abstract

: Sarcopenia is defined as loss of skeletal muscle mass, strength, and function, and it is associated with increased morbidity and mortality in patients with chronic liver disease.: The aim of this review is to provide a detailed report on the pathophysiological mechanisms underlying sarcopenia in cirrhotic patients, the several imaging methods available for the assessment of sarcopenia and the clinical studies evaluating the prognostic role of sarcopenia presence in cirrhotic patients.: Sarcopenia pathogenesis is complex and multifaceted, as chronic catabolic conditions, increased energy expenditure, reduced appetite, side effects of multiple therapies, alterations in circulating levels of hormones, low protein synthesis, presence of ascites or portosystemic shunts are all factors contributing to muscle atrophy in cirrhotic patients. Computed tomography scan is the most validated method to evaluate muscle mass and quality. Sarcopenia is associated with a higher rate waitlist mortality, hepatic encephalopathy, and lower quality of life in patients with liver cirrhosis. Future studies should make an effort to unify and validate liver disease-specific cutoffs for the definition of sarcopenia.

摘要

肌肉减少症是指骨骼肌质量、力量和功能的丧失,它与慢性肝病患者的发病率和死亡率增加有关。本综述的目的是详细报告肝硬化患者肌肉减少症的病理生理机制,可用于评估肌肉减少症的几种影像学方法,以及评估肌肉减少症在肝硬化患者中的预后作用的临床研究。肌肉减少症的发病机制复杂且多方面,因为慢性分解代谢状态、能量消耗增加、食欲减退、多种治疗的副作用、循环激素水平的改变、低蛋白合成、腹水或门体分流的存在都会导致肝硬化患者的肌肉萎缩。计算机断层扫描是评估肌肉质量和质量最有效的方法。肌肉减少症与肝硬化患者的更高的等待名单死亡率、肝性脑病和较低的生活质量相关。未来的研究应该努力统一和验证针对肝脏疾病的肌肉减少症定义的特异性截止值。

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