Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
Department of Gastroenterology, Changzheng Hospital, Navy Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
Hepatol Int. 2024 Apr;18(2):673-687. doi: 10.1007/s12072-023-10497-x. Epub 2023 Jun 18.
We aimed to determine the diagnostic criteria of myosteatosis in a Chinese population and investigate the effect of skeletal muscle abnormalities on the outcomes of cirrhotic patients.
Totally 911 volunteers were recruited to determine the diagnostic criteria and impact factors of myosteatosis, and 480 cirrhotic patients were enrolled to verify the value of muscle alterations for prognosis prediction and establish new noninvasive prognostic strategies.
Multivariate analysis showed age, sex, weight, waist circumference, and biceps circumference had a remarkable influence on the L3 skeletal muscle density (L3-SMD). Based on the cut-off of a mean - 1.28 × SD among adults aged < 60 years, the diagnostic criteria for myosteatosis was L3-SMD < 38.93 Hu in males and L3-SMD < 32.82 Hu in females. Myosteatosis rather than sarcopenia has a close correlation with portal hypertension. The concurrence of sarcopenia and myosteatosis not only is associated with poor liver function but also evidently reduced the overall and liver transplantation-free survival of cirrhotic patients (p < 0.001). According to the stepwise Cox regression hazard model analysis, we established nomograms including TBil, albumin, history of HE, ascites grade, sarcopenia, and myosteatosis for easily determining survival probabilities in cirrhotic patients. The AUC is 0.874 (95% CI 0.800-0.949) for 6-month survival, 0.831 (95% CI 0.764-0.898) for 1-year survival, and 0.813 (95% CI 0.756-0.871) for 2-year survival prediction, respectively.
This study provides evidence of the significant correlation between skeletal muscle alterations and poor outcomes of cirrhosis, and establishes valid and convenient nomograms incorporating musculoskeletal disorders for the prognostic prediction of liver cirrhosis. Further large-scale prospective studies are necessary to verify the value of the nomograms.
本研究旨在确定中国人肌少症的诊断标准，并探讨骨骼肌异常对肝硬化患者结局的影响。
共纳入 911 名志愿者来确定肌少症的诊断标准和影响因素，同时纳入 480 例肝硬化患者来验证肌肉改变对预后预测的价值并建立新的非侵入性预后策略。
多因素分析显示，年龄、性别、体重、腰围和肱二头肌围度对 L3 骨骼肌密度（L3-SMD）有显著影响。基于 60 岁以下成年人的均值减去 1.28 ×标准差，男性肌少症的诊断标准为 L3-SMD＜38.93 Hu，女性为 L3-SMD＜32.82 Hu。与肌少症相比，肝硬化患者的门脉高压与骨骼肌减少症更为密切相关。肌少症与肌少症并存不仅与肝功能不良密切相关，而且明显降低了肝硬化患者的总生存率和肝移植无生存率（p＜0.001）。根据逐步 Cox 回归风险模型分析，我们建立了包含总胆红素、白蛋白、HE 病史、腹水分级、肌少症和肌少症的列线图，以便更准确地确定肝硬化患者的生存率。该列线图在 6 个月、1 年和 2 年生存率预测中的 AUC 分别为 0.874（95%CI 0.800-0.949）、0.831（95%CI 0.764-0.898）和 0.813（95%CI 0.756-0.871）。
本研究提供了骨骼肌改变与肝硬化不良结局显著相关的证据，并建立了包含肌肉骨骼疾病的有效、方便的列线图，用于预测肝硬化的预后。需要进一步的大规模前瞻性研究来验证这些列线图的价值。
