Children's Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Childhood Nutrition Research Centre, University College London, London, UK.
Pediatr Transplant. 2024 Aug;28(5):e14767. doi: 10.1111/petr.14767.
Sarcopenia predicts morbidity and mortality in end-stage chronic liver disease (ESCLD). Here, we describe changes in body composition in children with ESCLD before and after liver transplantation (LT).
Retrospective analysis of whole body DXA scans performed before and after LT over 4 years. Appendicular and whole-body fat mass and lean mass were expressed as fat mass (FMI) and lean mass (LMI) index z-scores. Sarcopenia was defined as leg LMI z-score <-1.96.
Eighty-three DXA scans of children before or after LT were studied. Sarcopenia had a positive correlation with weight (0.8, p < .01), height (0.48, p < .05), and BMI z-score (0.77, p < .01), as well as arm, trunk, and total mean mass indices. It correlated negatively with indices of hypersplenism: PLTs (-0.57, p < .01), Neu (-0.50, p < .05), WCC (-0.44, p < .05), and days to discharge (-0.46, p < .05). At baseline: 13/25 (52%) children were sarcopenic and stayed in the hospital after LT for longer. Eight were stunted with a higher WCC and Ne/Ly ratio. All had normal FM indices. One year after LT, 12/26 children remained sarcopenic. Seven were stunted. Two years after LT, 5/15 were sarcopenic, and 5 were stunted. Three years after LT, 1/10 was sarcopenic, and 2 were stunted. By 4 years after LT, 1/7 was sarcopenic, and the same one was stunted. FM indices remained normal.
Sarcopenic patients stayed longer in the hospital after LT. Lean mass indices were mostly within the normal range by 4 years after LT. 32% of children were stunted, and markers of inflammation were correlated with stunting. Fat mass was preserved at the cost of lean mass.
肌肉减少症可预测终末期慢性肝病（ESCLD）患者的发病率和死亡率。在这里，我们描述了儿童在肝移植（LT）前后 ESCLD 患者的身体成分变化。
对 4 年内 LT 前后进行的全身 DXA 扫描进行回顾性分析。四肢和全身脂肪量和瘦体重以脂肪量（FMI）和瘦体重（LMI）指数 z 分数表示。肌肉减少症定义为下肢 LMI z 分数<-1.96。
研究了 83 例 LT 前后儿童的 DXA 扫描。肌肉减少症与体重（0.8，p<.01）、身高（0.48，p<.05）和 BMI z 分数（0.77，p<.01）呈正相关，与手臂、躯干和总平均质量指数呈负相关。它与脾肿大指数呈负相关：血小板（PLTs）（-0.57，p<.01）、中性粒细胞（Neu）（-0.50，p<.05）、白细胞（WCC）（-0.44，p<.05）和出院天数（-0.46，p<.05）。在基线时：25 名儿童中有 13 名（52%）为肌肉减少症，且在 LT 后住院时间更长。8 名儿童身材矮小，WCC 和 Ne/Ly 比值较高。所有儿童的 FM 指数均正常。LT 后 1 年，26 名儿童中有 12 名仍为肌肉减少症。7 名儿童身材矮小。LT 后 2 年，15 名儿童中有 5 名肌肉减少症，5 名儿童身材矮小。LT 后 3 年，10 名儿童中有 1 名肌肉减少症，2 名儿童身材矮小。LT 后 4 年，7 名儿童中有 1 名肌肉减少症，且与一名身材矮小的儿童相同。FM 指数仍在正常范围内。
肌肉减少症患者 LT 后住院时间更长。LT 后 4 年内，瘦体重指数大多在正常范围内。32%的儿童身材矮小，炎症标志物与身材矮小有关。脂肪量的增加是以瘦体重为代价的。
