Nakamura Atsushi, Yoshimura Tsubasa, Sato Tomomi, Ichikawa Takeshi
Hepatology, Nippon Koukan Hospital, Kawasaki, JPN.
Gastroenterology, Nippon Koukan Hospital, Kawasaki, JPN.
Cureus. 2022 May 2;14(5):e24676. doi: 10.7759/cureus.24676. eCollection 2022 May.
Background Liver magnetic resonance imaging (MRI) is rarely used to evaluate sarcopenia. This study sought to develop new diagnostic criteria for MRI in Asians and investigate the relationship between adipopenia and sarcopenia using MRI proton density fat fraction (PDFF), which is correlated with body fat mass. Methodology This study included 512 patients with chronic liver disease (CLD) who underwent magnetic resonance elastography (MRE). The following parameters were assessed: paraspinal muscle area/height index (PSMI) measured at the level of the superior mesenteric artery and PDFF. The cutoff PSMI and PDFF values for the diagnosis of sarcopenia and adipopenia, respectively, were determined using receiver operating characteristic analysis of Asians with low body mass index. Results Among patients with CLD, the prevalence rates of sarcopenia and adipopenia were 25% and 17%, respectively. We found that sarcopenia increased from stage 3 fibrosis and was inversely correlated with steatosis grade. Multivariate analysis found that MRI-PDFF was associated with sarcopenia. The Kaplan-Meier method in cirrhosis (n = 122) showed that the non-sarcopenia, sarcopenia, and sarcopenia/adipopenia groups had three-year survival rates of 97%, 55% (p < 0.01), and 23%, respectively. The Cox proportional hazards model identified the Child-Pugh score and sarcopenia/adipopenia as independent prognostic factors. Conclusions The new diagnostic criteria for sarcopenia confirmed that the prognosis of cirrhosis can be stratified. Furthermore, sarcopenia with adipopenia was shown to be a phenotype of severe sarcopenia in cirrhosis, and screening for sarcopenia should include cases in the precirrhotic stage.
背景 肝脏磁共振成像（MRI）很少用于评估肌肉减少症。本研究旨在制定亚洲人MRI的新诊断标准，并使用与体脂质量相关的MRI质子密度脂肪分数（PDFF）研究脂肪减少与肌肉减少症之间的关系。方法 本研究纳入了512例接受磁共振弹性成像（MRE）的慢性肝病（CLD）患者。评估了以下参数：在肠系膜上动脉水平测量的椎旁肌面积/身高指数（PSMI）和PDFF。分别使用低体重指数亚洲人的受试者工作特征分析确定诊断肌肉减少症和脂肪减少症的PSMI和PDFF临界值。结果 在CLD患者中，肌肉减少症和脂肪减少症的患病率分别为25%和17%。我们发现肌肉减少症从3期纤维化开始增加，并且与脂肪变性分级呈负相关。多变量分析发现MRI-PDFF与肌肉减少症相关。肝硬化患者（n = 122）的Kaplan-Meier方法显示，非肌肉减少症、肌肉减少症和肌肉减少症/脂肪减少症组的三年生存率分别为97%、55%（p < 0.01）和23%。Cox比例风险模型确定Child-Pugh评分和肌肉减少症/脂肪减少症为独立的预后因素。结论 肌肉减少症的新诊断标准证实肝硬化的预后可以分层。此外，脂肪减少合并肌肉减少症被证明是肝硬化中严重肌肉减少症的一种表型，并且肌肉减少症的筛查应包括肝硬化前期的病例。
