Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.
J Gastroenterol Hepatol. 2021 Oct;36(10):2687-2705. doi: 10.1111/jgh.15474. Epub 2021 Mar 10.
Reduction in muscle mass is a highly prevalent phenomenon in cirrhosis and is now well-documented to be associated with significant morbidity and mortality. Research into muscle loss in cirrhosis remains limited by an ongoing poor understanding of its relationship with muscle function, physical activity, and aerobic capacity. Alterations in exercise physiology have been documented in studies of individuals with cirrhosis that provide important information on physical function that is not captured by simple quantification of muscle mass. Despite expert consensus recommending regular exercise in end-stage liver disease to maintain muscle mass and function, there is little evidence guiding clinicians as to which form of exercise or delivery mechanism is most effective. It also remains unproven whether any specific intervention can alter clinically relevant outcomes. This review article summarizes the available literature regarding the changes in exercise physiology observed in cirrhosis, the associated impact on physical capacity, and the results of existing trials that examine the potential benefits of exercise delivery in patients with cirrhosis, particularly pertaining to their impact on exercise physiology.
肌肉减少症是肝硬化中非常普遍的现象，现在已有充分的证据表明其与较高的发病率和死亡率相关。由于对其与肌肉功能、身体活动和有氧能力的关系仍缺乏深入了解，因此对肝硬化中肌肉减少的研究仍然受到限制。在肝硬化患者的研究中已经记录了运动生理学的改变，这些改变提供了关于身体功能的重要信息，这些信息无法通过简单地量化肌肉质量来捕捉。尽管专家共识建议终末期肝病患者定期运动以维持肌肉质量和功能，但几乎没有证据可以指导临床医生选择哪种运动形式或输送机制最有效。此外，任何特定的干预措施是否可以改变临床相关结局也尚未得到证实。本文综述了有关肝硬化患者观察到的运动生理学变化、对身体能力的影响以及现有试验的结果，这些试验检查了运动输送对肝硬化患者的潜在益处，特别是对其对运动生理学的影响。
