Shibamoto Akihiko, Namisaki Tadashi, Suzuki Junya, Kubo Takahiro, Iwai Satoshi, Tomooka Fumimasa, Takeda Soichi, Fujimoto Yuki, Enomoto Masahide, Murata Koji, Inoue Takashi, Tsuji Yuki, Fujinaga Yukihisa, Nishimura Norihisa, Kitagawa Koh, Takaya Hiroaki, Kaji Kosuke, Kawaratani Hideto, Akahane Takemi, Mitoro Akira, Yoshiji Hitoshi
Department of Gastroenterology, Nara Medical University, Kashihara, Japan.
Department of Evidence-Based Medicine, Nara Medical University, Kashihara, Japan.
Hepatol Res. 2023 Aug;53(8):713-722. doi: 10.1111/hepr.13904. Epub 2023 Apr 28.
This study aimed to elucidate a surrogate marker of sarcopenia in patients with liver cirrhosis (LC).
A total of 424 patients were assessed for handgrip strength (HGS) and skeletal muscle index (SMI). They were divided into two groups: sarcopenia (Group S; n = 80) and nonsarcopenia (Group NS; n = 344).
Group S showed significantly lower HGS, SMI, and hemoglobin (Hb) levels in males and female patients, and lower serum levels of albumin, cholinesterase, and zinc (all p < 0.001), along with significantly higher serum levels of procollagen type III-N-peptide and type IV collagen 7S-domain (p < 0.001 and p < 0.0017) than Group NS. The risk factors for sarcopenia were age 65 years or older, female gender, Child-Pugh class C, and Hb levels <10.9 g/dL in women and <12.4 g/dL in men (p = 0.012, p < 0.001, p = 0.031, and p < 0.001, respectively). Significant positive correlations were found between the Hb level and the SMI and HGS (r = 0.4, p < 0.001 and r = 0.4, p < 0.001, respectively). Sarcopenia, low HGS, and low SMI were significantly associated with overall survival in patients with LC (all p < 0.001). The predictive accuracy of Hb levels for predicting sarcopenia was significantly higher than for predicting SMI and tended to be higher than for predicting HGS (p = 0.014 and p = 0.059, respectively).
Hemoglobin levels are predictive of sarcopenia in patients with LC and warrants further investigation as a biomarker for sarcopenia in LC.
本研究旨在阐明肝硬化（LC）患者肌肉减少症的替代标志物。
共评估了424例患者的握力（HGS）和骨骼肌指数（SMI）。他们被分为两组：肌肉减少症组（S组；n = 80）和非肌肉减少症组（NS组；n = 344）。
S组男性和女性患者的HGS、SMI和血红蛋白（Hb）水平显著较低，血清白蛋白、胆碱酯酶和锌水平也较低（均p < 0.001），同时血清III型前胶原N端肽和IV型胶原7S结构域水平显著高于NS组（p < 0.001和p < 0.0017）。肌肉减少症的危险因素为年龄65岁及以上、女性、Child-Pugh C级，女性Hb水平<10.9 g/dL，男性Hb水平<12.4 g/dL（分别为p = 0.012、p < 0.001、p = 0.031和p < 0.001）。Hb水平与SMI和HGS之间存在显著正相关（分别为r = 0.4，p < 0.001和r = 0.4，p < 0.001）。肌肉减少症、低HGS和低SMI与LC患者的总生存期显著相关（均p < 0.001）。Hb水平预测肌肉减少症的准确性显著高于预测SMI，且倾向于高于预测HGS（分别为p = 0.014和p = 0.059）。
血红蛋白水平可预测LC患者的肌肉减少症，作为LC中肌肉减少症的生物标志物值得进一步研究。
