Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Ann Palliat Med. 2021 Apr;10(4):3976-3987. doi: 10.21037/apm-20-2059. Epub 2021 Mar 22.
The causal relationship between sarcopenia and depression in chronic liver disease (CLD) patients is unclear. To elucidate these issues, we aimed to investigate the impacts of muscle strength as assessed by grip strength (GS) and muscle mass as assessed by bioelectrical impedance analysis (BIA) on the progression of depression in CLD patients (n=189, 49 cirrhotic cases, and 87 males).
The Beck Depression Inventory-2nd edition (BDI-II) was used for the evaluation of depression. Time interval from the date of baseline BDI-II and the first confirmed date of elevation of BDI-II score was calculated in each subject. We analyzed factors associated with the elevation of BDI-II score.
The baseline mean BDI-II score was 8.4 (median value, 7). Depression (BDI-II score >11) was found in 63 patients (33.33%). GS decline at baseline was found in 13 male patients (14.9%) and 37 female patients (36.3%). Skeletal muscle index (SMI) by BIA decline at baseline was found in 25 male patients (28.7%) and 40 female patients (39.2%). During the follow-up period, 84 patients (44.4%) had the elevation of BDI-II score. For all cases, the 1-, 2- and 3-year cumulative elevation rates of BDI-II score were 39.2%, 46.6% and 54.9%. In patients with GS decline at baseline, the 1-, 2- and 3-year cumulative elevation rates of BDI-II score were 53.1%, 67.8% and 77.9%, while in patients with GS non-decline at baseline, the 1-, 2- and 3-year cumulative elevation rates of BDI-II score were 34.4%, 39.8% and 47.4% (P=0.0006). In patients with SMI decline at baseline, the 1-, 2- and 3-year cumulative elevation rates of BDI-II score were 43.5%, 50.8% and 62.1%, while in patients with SMI non-decline at baseline, the 1-, 2- and 3-year cumulative elevation rates of BDI-II score were 36.9%, 44.5% and 51.0% (P=0.2487). As per the multivariate analyses, only lower GS at baseline (P=0.0022) was identified to be a significant factor associated with the elevation of BDI-II score.
Reduced GS rather than loss of muscle mass can be independently associated with an elevated risk for the progression of depression.
在慢性肝病（CLD）患者中，肌肉减少症与抑郁症之间的因果关系尚不清楚。为了阐明这些问题，我们旨在研究通过握力（GS）评估的肌肉力量和通过生物电阻抗分析（BIA）评估的肌肉质量对 CLD 患者（n=189，49 例肝硬化病例和 87 例男性）中抑郁症进展的影响。
使用贝克抑郁量表第二版（BDI-II）评估抑郁情况。在每个受试者中，计算从基线 BDI-II 日期到首次确认 BDI-II 评分升高的时间间隔。我们分析了与 BDI-II 评分升高相关的因素。
基线时平均 BDI-II 评分为 8.4（中位数为 7）。63 名患者（33.33%）存在抑郁（BDI-II 评分>11）。13 名男性患者（14.9%）和 37 名女性患者（36.3%）在基线时出现 GS 下降。25 名男性患者（28.7%）和 40 名女性患者（39.2%）在基线时出现 BIA 测量的骨骼肌指数（SMI）下降。在随访期间，84 名患者（44.4%）BDI-II 评分升高。对于所有病例，BDI-II 评分的 1 年、2 年和 3 年累积升高率分别为 39.2%、46.6%和 54.9%。在基线时出现 GS 下降的患者中，BDI-II 评分的 1 年、2 年和 3 年累积升高率分别为 53.1%、67.8%和 77.9%，而在基线时 GS 未下降的患者中，BDI-II 评分的 1 年、2 年和 3 年累积升高率分别为 34.4%、39.8%和 47.4%（P=0.0006）。在基线时出现 SMI 下降的患者中，BDI-II 评分的 1 年、2 年和 3 年累积升高率分别为 43.5%、50.8%和 62.1%，而在基线时 SMI 未下降的患者中，BDI-II 评分的 1 年、2 年和 3 年累积升高率分别为 36.9%、44.5%和 51.0%（P=0.2487）。多变量分析显示，只有基线时较低的 GS（P=0.0022）被确定为与 BDI-II 评分升高相关的显著因素。
与肌肉质量损失相比，GS 降低可能与抑郁症进展的风险增加独立相关。
