Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University.
National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University.
Curr Opin Gastroenterol. 2023 May 1;39(3):131-139. doi: 10.1097/MOG.0000000000000922. Epub 2023 Mar 1.
With the development of many international guidelines, research on sarcopenia has increased rapidly, showing that sarcopenia is predictive of adverse outcomes, including increased mortality and impaired mobility, in patients with cirrhosis. The purpose of this article is to review the current evidence concerning the epidemiology, diagnosis, management and predictive value of sarcopenia on the prognosis of patients with cirrhosis.
Sarcopenia is a frequent and lethal complication of cirrhosis. Currently, abdominal computed tomography imaging is the most commonly used method to diagnose sarcopenia. In clinical practice, assessing muscle strength and physical performance, such as by measuring handgrip strength and gait speed, is of increasing interest. In addition to the necessary pharmacological therapy, adequate intake of protein, energy and micronutrients, as well as regular moderate-intensity exercise, can help to minimize sarcopenia. Sarcopenia has been shown to be a strong predictor of prognosis in patients with severe liver disease.
A global consensus is needed on the definition and operational parameters for the diagnosis of sarcopenia. Further research should focus on developing standardized screening, management and treatment protocols for sarcopenia. Adding sarcopenia to existing models may better exploit the effect of sarcopenia on prognosis in patients with cirrhosis, which should be investigated further.
随着众多国际指南的发展，肌肉减少症的研究迅速增加，研究表明肌肉减少症可预测肝硬化患者的不良结局，包括死亡率增加和活动能力受损。本文旨在综述目前关于肝硬化患者肌肉减少症的流行病学、诊断、治疗以及对预后预测价值的证据。
肌肉减少症是肝硬化的常见且致命的并发症。目前，腹部计算机断层扫描成像（CT）是诊断肌肉减少症最常用的方法。在临床实践中，评估肌肉力量和身体机能（如握力和步速）越来越受到关注。除了必要的药物治疗外，充足的蛋白质、能量和微量营养素摄入以及规律的中等强度运动有助于最大限度地减少肌肉减少症。肌肉减少症是严重肝病患者预后的强有力预测指标。
需要就肌肉减少症的定义和操作参数达成全球共识。进一步的研究应集中于制定肌肉减少症的标准化筛查、管理和治疗方案。将肌肉减少症纳入现有的模型中可能会更好地利用其对肝硬化患者预后的影响，这需要进一步研究。
