Singh Surender, Taneja Sunil, Tandon Puneeta, De Arka, Verma Nipun, Premkumar Madhumita, Duseja Ajay, Dhiman Radha Krishan, Singh Virendra
Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Division of Gastroenterology, University of Alberta, Edmonton, Canada.
J Clin Exp Hepatol. 2022 May-Jun;12(3):800-807. doi: 10.1016/j.jceh.2021.11.012. Epub 2021 Nov 26.
BACKGROUND/AIM: Hormonal changes and hepatic osteodystrophy are less often studied complications of cirrhosis. This study describes the variance in hormones and osteodystrophy between Frail and Not frail patients with cirrhosis.
116 outpatients with cirrhosis were prospectively enrolled in this study. Frailty assessment was done using Liver Frailty Index (LFI). Sociodemographic assessment, anthropometry, nutritional assessment, hormone profile, and dual-energy X-ray absorptiometry scan were done in all patients.
116 patients, predominantly males (100 (86.2%) with mean age of 50.16 years (95% CI, 48.43-51.89) were included. Malnutrition was more common in Frail group as compared to Not frail group. Subjective global assessment (SGA) class-B patients were significantly more in Frail group (37 (74%) vs 3 (4.5%), = 0.001). The prevalence of lower parathyroid hormone (PTH) (14 (28%) vs 2 (3%)), testosterone (33 (66%) vs 15 (22.7%)), vitamin D3 (44 (88%) vs 39 (59.1%)), and cortisol (37 (74%) vs 37 (56.1) levels was higher in Frail group ( < 0.05). The number of patients diagnosed with osteodystrophy (34 (68%) vs 21 (31.8%), = 0.001) was significantly higher in Frail group. The marker of osteoclastic activity, β-cross laps, was significantly elevated in the Frail group both in males (736 (655-818) vs 380 (329-432), = 0.001) and (females 619 (479-758) vs 313 (83-543), = 0.02). Bone mineral density (BMD) at lumbar spine (LS) and neck of femur (NF) had significant correlation with LFI (ρ = 0.60, = 0.001 for LS and ρ = 0.59, = 0.001 for NF), serum testosterone (ρ = 0.58, = 0.001 for LS and ρ = 0.53, = 0.001 for NF), β-cross laps (ρ = 0.38, = 0.001for LS and ρ = 0.35, = 0.000 for NF), vitamin D3 (ρ = 0.23, = 0.04 for LS and ρ = 0.25, = 0.01 for NF), PTH (ρ = 0.52, = 0.001 for LS and ρ = 0.48. = 0.001 for NF), and cortisol (ρ = 0.50, = 0.001 for LS and ρ = 0.45, = 0.001 for NF) levels.
This is the first study that highlights the high prevalence of hormonal changes and hepatic osteodystrophy in frail patients with cirrhosis and opens a new dimension for research and target of therapy in this field.
背景/目的：激素变化和肝性骨营养不良是肝硬化较少被研究的并发症。本研究描述了肝硬化虚弱患者和非虚弱患者之间激素和骨营养不良的差异。
116例肝硬化门诊患者前瞻性纳入本研究。使用肝脏虚弱指数（LFI）进行虚弱评估。对所有患者进行社会人口统计学评估、人体测量、营养评估、激素谱分析和双能X线吸收法扫描。
纳入116例患者，以男性为主（100例（86.2%）），平均年龄50.16岁（95%可信区间，48.43 - 51.89）。与非虚弱组相比，营养不良在虚弱组中更常见。主观全面评定（SGA）B级患者在虚弱组中显著更多（37例（74%）对3例（4.5%），P = 0.001）。虚弱组中甲状旁腺激素（PTH）降低（14例（28%）对2例（3%））、睾酮（33例（66%）对15例（22.7%））、维生素D3（44例（88%）对39例（59.1%））和皮质醇（37例（74%）对37例（56.1%））水平的患病率更高（P < 0.05）。诊断为骨营养不良的患者数量在虚弱组中显著更高（34例（68%）对21例（31.8%），P = 0.001）。破骨细胞活性标志物β-交联C端肽在虚弱组男性（736（655 - 818）对380（329 - 432），P = 0.001）和女性（619（479 - 758）对313（83 - 543），P = 0.02）中均显著升高。腰椎（LS）和股骨颈（NF）的骨密度（BMD）与LFI（LS的ρ = 0.60，P = 0.001；NF的ρ = 0.59，P = 0.001）、血清睾酮（LS的ρ = 0.58，P =
