Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Tohoku University School of Medicine, Sendai, Miyagi, Japan.
Nutrition. 2021 Apr;84:111007. doi: 10.1016/j.nut.2020.111007. Epub 2020 Sep 2.
Sarcopenia worsens the prognosis of patients with hepatocellular carcinoma (HCC). The aim of this study was to elucidate the plasma free amino acids (PFAAs) associated with sarcopenia or myosteatosis in the course of HCC recurrence.
In this cross-sectional study, 187 patients were enrolled retrospectively. All patients experienced more than one hospitalization (mean times, 2.65) owing to HCC recurrence. The skeletal muscle index (SMI) and muscle attenuation (MA) were measured by a transverse computed tomography (CT) scan image at the third lumbar vertebra (L3). The changes in the concentration of 24 PFAAs, SMI, and MA in the same patient between recurrences were defined as Δ. The associations between sarcopenia, myosteatosis, and PFAAs were evaluated by a logistic regression model. The ΔSMI and ΔMA were compared between the patients who received branched-chain amino acids (BCAAs) formulation and those who did not.
Patients with sarcopenia showed lower survival rate; the 1-, 3-, and 5-y survival rates were 85%, 42%, and 9%, respectively. Multivariate analysis revealed that the level of total BCAAs was significantly associated with sarcopenia. The correlation coefficient value between the change of leucine (ΔLeu) and ΔSMI was highest (R = 0.256; P < 0.001) among the PFAAs. In the Child-Pugh grade B or C, the decrease of SMI was significantly more suppressed in the patients with the BCAAs formulation than in those without BCAAs formulation (ΔSMI: mean change -0.98 versus -3.45 cm²/m²; P = 0.038).
Among the PFAAs, the level of BCAAs was associated with sarcopenia in the course of HCC recurrence.
肌肉减少症会使肝细胞癌（HCC）患者的预后恶化。本研究旨在阐明 HCC 复发过程中与肌肉减少症或肌脂过多相关的血浆游离氨基酸（PFAAs）。
本横断面研究回顾性纳入 187 例患者。所有患者因 HCC 复发均经历了多次住院治疗（平均次数 2.65 次）。通过第三腰椎（L3）的横断位 CT 扫描图像测量骨骼肌指数（SMI）和肌肉衰减（MA）。将同一患者在复发期间 PFAAs、SMI 和 MA 浓度的变化定义为Δ。通过逻辑回归模型评估肌肉减少症、肌脂过多与 PFAAs 之间的关系。比较接受支链氨基酸（BCAA）配方和未接受 BCAA 配方的患者之间的ΔSMI 和ΔMA。
肌肉减少症患者的生存率较低；1、3 和 5 年的生存率分别为 85%、42%和 9%。多变量分析显示，总 BCAA 水平与肌肉减少症显著相关。在 PFAAs 中，亮氨酸（ΔLeu）与ΔSMI 的相关系数值最高（R=0.256；P<0.001）。在 Child-Pugh 分级 B 或 C 中，与未接受 BCAA 配方的患者相比，接受 BCAA 配方的患者的 SMI 下降幅度明显受到抑制（ΔSMI：平均变化-0.98 与-3.45 cm²/m²；P=0.038）。
在 PFAAs 中，BCAA 水平与 HCC 复发过程中的肌肉减少症相关。
