骨密度降低与失代偿期肝硬化女性患者经颈静脉肝内门体分流术后的生存率相关。
Reduced bone mineral density is associated to post-TIPS survival of female patients with decompensated cirrhosis.
作者信息
Reincke Marlene, Seufert Jochen, Laubner Katharina, Meyer-Steenbuck Maximilian, Dammer Anna, Sturm Lukas, Thimme Robert, Bettinger Dominik, Schultheiss Michael
机构信息
Department of Medicine II, Division of Gastroenterology and Hepatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
Department of Medicine II, Division of Endocrinology and Diabetology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
出版信息
Dig Liver Dis. 2024 Oct;56(10):1705-1714. doi: 10.1016/j.dld.2024.04.009. Epub 2024 Apr 27.
BACKGROUND
Malnutrition is common in patients with cirrhosis, eventually leading to sarcopenia and loss of bone mass.
AIMS
The aims of this study was the assessment of body composition (BC) and bone mineral density (BMD) in patients with decompensated cirrhosis and the prognostic impact on survival after transjugular intrahepatic portosystemic shunt (TIPS) implantation.
METHODS
BMD and BC of 107 patients with cirrhosis undergoing TIPS implantation were prospectively analyzed by dual-energy X-ray absorptiometry. The prevalence and predisposing risk factors for reduced BMD and sarcopenia were assessed. Impact on 12-month survival after TIPS implantation was evaluated.
RESULTS
Sarcopenia was diagnosed in 48.6 % of the patients with a predominance of male patients (58.7% vs. 25.0 %, p = 0.001). 67.2 % had reduced BMD. Low BMI was independently associated with sarcopenia (OR 0.751 (95 % CI: 0.662;0.852), p < 0.001) and reduced BMD (OR 0.851 (0.773;0.937), p = 0.001). Patients with reduced BMD, but not sarcopenia, had impaired 12-month survival after TIPS-implantation (61.2% vs. 82.9 %, p = 0.030). Subgroup analysis showed that this was especially valid for female patients.
CONCLUSIONS
Sarcopenia and reduced BMD are frequently observed in patients with decompensated cirrhosis. Reduced BMD negatively affects post-TIPS survival. Since malnutrition is a leading cause, assessment of nutritional status and specific treatment should be included in clinical practice.
背景
营养不良在肝硬化患者中很常见，最终会导致肌肉减少症和骨质流失。
目的
本研究旨在评估失代偿期肝硬化患者的身体成分（BC）和骨矿物质密度（BMD），以及经颈静脉肝内门体分流术（TIPS）植入术后对生存的预后影响。
方法
采用双能X线吸收法对107例接受TIPS植入术的肝硬化患者的BMD和BC进行前瞻性分析。评估BMD降低和肌肉减少症的患病率及易感危险因素。评估对TIPS植入术后12个月生存率的影响。
结果
48.6%的患者被诊断为肌肉减少症，其中男性患者占多数（58.7%对25.0%，p = 0.001）。67.2%的患者BMD降低。低体重指数与肌肉减少症（OR 0.751（95%CI：0.662；0.852），p < 0.001）和BMD降低（OR 0.851（0.773；0.937），p = 0.001）独立相关。BMD降低但非肌肉减少症的患者在TIPS植入术后12个月生存率受损（61.2%对82.9%，p = 0.030）。亚组分析表明，这对女性患者尤为明显。
结论
失代偿期肝硬化患者中经常观察到肌肉减少症和BMD降低。BMD降低对TIPS术后生存有负面影响。由于营养不良是主要原因，临床实践中应包括营养状况评估和特异性治疗。
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