Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
Department of Radiology, "St. Spiridon" Emergency Hospital, 700111 Iasi, Romania.
Medicina (Kaunas). 2021 Nov 10;57(11):1226. doi: 10.3390/medicina57111226.
: Sarcopenia is commonly associated with liver cirrhosis and predicts clinical outcome. Our aim was to identify the changes in skeletal muscle index (SMI) on computed tomography (CT) examination, as a quantitative marker of sarcopenia, in patients with HCV-related cirrhosis after direct acting antivirals (DAAs) treatment and to assess predictive factors for the evolution of SMI. This is a single center retrospective study in patients with HCV-related compensated cirrhosis who obtained sustained virological response (SVR) after DAAs. CT examinations were performed in 52 patients before and within 5-24 months after treatment. The total muscle area () of abdominal muscle at the level of third lumbar vertebra (L3) was measured at baseline and after SVR. The L3-SMI was calculated from divided by body height squared (cm/m). We assessed changes in L3-SMI after SVR according to baseline body mass index (BMI) and laboratory data. Predictive factors were assessed by linear regression model. Patients with L3-SMI above the gender-specific cut-off value at baseline had higher values of serum creatinine (median 0.73) compared to patients with low L3-SMI (median 0.68, = 0.031). After SVR, 14 patients showed increase of L3-SMI, and 38 patients had a decrease of L3-SMI. BMI in the decreased L3-SMI group was significantly lower (median 26.17) than those without decreased L3-SMI (median 28.84, = 0.021). ALT values in the decreased L3-SMI group (median 66.5) were significantly lower than those without a decrease in L3-SMI (median 88, = 0.045). Low creatinine serum level correlates with sarcopenia. SMI was partially influenced by the viral clearance. Lower BMI and ALT serum levels at baseline were predictive for no benefit in terms of muscle mass dynamics. Understanding all the mechanisms involved in sarcopenia and identifying the most vulnerable patients could ensure optimal adapted care strategies.
肌肉减少症通常与肝硬化相关，并预测临床结局。我们的目的是确定 HCV 相关肝硬化患者在直接作用抗病毒药物（DAA）治疗后，通过 CT 检查获得的骨骼肌指数（SMI）变化，作为肌肉减少症的定量标志物，并评估 SMI 演变的预测因素。 这是一项单中心回顾性研究，纳入了获得 DAA 治疗后持续病毒学应答（SVR）的 HCV 相关代偿性肝硬化患者。52 例患者在基线时和治疗后 5-24 个月内进行 CT 检查。在基线和 SVR 后，测量第三腰椎（L3）水平的腹部肌肉总肌区（ ）。L3-SMI 由 除以身高的平方（cm/m）计算得出。我们根据基线时的体重指数（BMI）和实验室数据评估 SVR 后 L3-SMI 的变化。通过线性回归模型评估预测因素。 基线时 L3-SMI 高于性别特异性截止值的患者的血清肌酐值（中位数 0.73）高于 L3-SMI 低的患者（中位数 0.68， = 0.031）。SVR 后，14 例患者 L3-SMI 增加，38 例患者 L3-SMI 降低。在 L3-SMI 降低组中，BMI（中位数 26.17）显著低于无 L3-SMI 降低组（中位数 28.84， = 0.021）。在 L3-SMI 降低组中，ALT 值（中位数 66.5）显著低于无 L3-SMI 降低组（中位数 88， = 0.045）。 低血清肌酐水平与肌肉减少症相关。SMI 部分受到病毒清除的影响。基线时较低的 BMI 和 ALT 血清水平是肌肉质量动态无获益的预测因素。了解肌肉减少症涉及的所有机制，并确定最脆弱的患者，可以确保采取最佳的适应性护理策略。
