Cui Binxin, Hui Yangyang, Sun Chao
Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital.
Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital.
Eur J Gastroenterol Hepatol. 2023 May 1;35(5):575-582. doi: 10.1097/MEG.0000000000002536. Epub 2023 Mar 18.
Dynapenia embraces clinical significance and predictive value separated from skeletal muscle loss among cirrhosis. Moreover, alterations in lipid levels may impact muscle function. It has yet to elucidate the relationship between lipid profiles and muscle strength weakness. We sought to explore which lipid metabolism indicator could be useful to identify patients with dynapenia in daily practice.
A retrospective observational cohort study enrolling 262 cirrhotic patients. Analysis of the receiver operating characteristic (ROC) curve was performed to determine the discriminatory cutoff for dynapenia. Multivariate logistic regression was conducted to assess the association between total cholesterol (TC) and dynapenia. Also, we established a model based on the classification and regression tree method.
ROC implicated a cutoff of TC ≤ 3.37 mmol/L to identify dynapenia. Patients with TC ≤ 3.37 mmol/L showed significantly lower handgrip strength (HGS; 20.0 vs. 24.7 kg, P = 0.003), lower hemoglobin, lower platelet, lower white blood cell count, lower sodium and higher prothrombin-international normalized ratio. A positive correlation was found between TC and HGS values ( r = 0.1860, P = 0.003). TC remained a significant association with dynapenia after controlling for variables including age, sex, BMI, and the presence of ascites. The decision tree incorporating TC, BMI, and age had a sensitivity of 71.4%, specificity of 64.9%, and an area under ROC of 0.681.
TC ≤ 3.37 mmol/L was significantly associated with the presence of dynapenia. Assessing TC may be helpful for identifying dynapenic patients with cirrhosis in the health care or hospital setting.
肌肉减少症具有临床意义和预测价值，与肝硬化患者的骨骼肌丢失情况不同。此外，血脂水平的改变可能会影响肌肉功能。目前尚未阐明血脂谱与肌肉力量减弱之间的关系。我们试图探索哪种脂质代谢指标在日常实践中有助于识别肌肉减少症患者。
一项回顾性观察队列研究纳入了262例肝硬化患者。进行受试者操作特征（ROC）曲线分析以确定肌肉减少症的判别临界值。进行多变量逻辑回归以评估总胆固醇（TC）与肌肉减少症之间的关联。此外，我们基于分类和回归树方法建立了一个模型。
ROC表明，TC≤3.37 mmol/L可用于识别肌肉减少症。TC≤3.37 mmol/L的患者握力（HGS）明显较低（20.0对24.7 kg，P = 0.003），血红蛋白、血小板、白细胞计数、钠水平较低，凝血酶原国际标准化比值较高。发现TC与HGS值之间存在正相关（r = 0.1860，P = 0.003）。在控制了年龄、性别、BMI和腹水存在等变量后，TC与肌肉减少症仍存在显著关联。纳入TC、BMI和年龄的决策树敏感性为71.4%，特异性为64.9%，ROC曲线下面积为0.681。
TC≤3.37 mmol/L与肌肉减少症的存在显著相关。评估TC可能有助于在医疗保健或医院环境中识别肝硬化肌肉减少症患者。
