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住院老年人群肌少症的对比分析:探讨肝硬化的影响。

Comparative analysis of Sarcopenia in hospitalized elderly: exploring the impact of liver cirrhosis.

机构信息

Internal Medicine and Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, 71122, Foggia, Italy.

出版信息

Intern Emerg Med. 2024 Oct;19(7):1949-1957. doi: 10.1007/s11739-024-03709-1. Epub 2024 Jul 19.

Abstract

The progressive aging of the population has led to a rise in geriatric pathologies, with sarcopenia, characterized by muscle mass and function loss, becoming a crucial prognostic indicator. This study investigates sarcopenia in elderly hospitalized patients with advanced chronic liver disease (cirrhotic) and non-liver disease patients, comparing their prevalence and exploring correlations with anthropometric and biochemical factors. The cohort of 115 patients, including 50 cirrhotic and 65 non-cirrhotic individuals, exhibited significant comorbidities and a mean age of 78.4 years. Cirrhotic patients presented distinct laboratory parameters indicating liver damage. Applying European Working Group on Sarcopenia in Older People criteria, probable sarcopenia prevalence was similar in cirrhotic (62%) and non-cirrhotic (63%) patients. Stratifying probable sarcopenia into confirmed sarcopenia and dynapenia revealed no significant differences between populations. Correlation analyses demonstrated positive associations between Appendicular Skeletal Muscle Mass (ASM) and anthropometric parameters, malnutrition risk, and grip strength. In cirrhotic patients, muscle mass inversely correlated with liver damage. Odds ratio analysis highlighted the Mini Nutritional Assesment's (MNA) significant predictive capability for sarcopenia. ROC curve analysis affirmed MNA and biochemical markers' combined use, such as transferrin, albumin, total cholesterol, lymphocyte count and C-reactive protein as a strong predictor. Despite limitations, such as a small sample size, this study underscores the significance of thorough sarcopenia screening in elderly hospitalized patients, especially those with cirrhosis. Indeed, individuals with end-stage liver disease are particularly susceptible to sarcopenia. A more personalized approach utilizing tools like MNA and biochemical markers could prove beneficial. Further research is warranted to validate these findings and inform clinical interventions.

摘要

人口老龄化导致老年病学的发病率上升,肌肉减少症是一种以肌肉质量和功能丧失为特征的疾病,成为一个重要的预后指标。本研究调查了老年住院患者中患有晚期慢性肝脏疾病(肝硬化)和非肝脏疾病患者的肌肉减少症,比较了它们的患病率,并探讨了与人体测量和生化因素的相关性。该队列包括 115 名患者,其中 50 名肝硬化患者和 65 名非肝硬化患者,这些患者都有显著的合并症,平均年龄为 78.4 岁。肝硬化患者的实验室参数表现出明显的肝脏损伤。应用欧洲老年人肌肉减少症工作组标准,肝硬化(62%)和非肝硬化(63%)患者的疑似肌肉减少症患病率相似。将疑似肌肉减少症分为确诊肌肉减少症和无力症,两组之间没有显著差异。相关性分析表明,四肢骨骼肌质量(ASM)与人体测量参数、营养不良风险和握力呈正相关。在肝硬化患者中,肌肉质量与肝损伤呈负相关。比值比分析强调了微型营养评估(MNA)对肌肉减少症的显著预测能力。ROC 曲线分析证实了 MNA 和生化标志物(如转铁蛋白、白蛋白、总胆固醇、淋巴细胞计数和 C 反应蛋白)的联合使用是一种强有力的预测指标。尽管存在样本量小等局限性,但本研究强调了对老年住院患者进行全面肌肉减少症筛查的重要性,尤其是对肝硬化患者。事实上,终末期肝病患者特别容易发生肌肉减少症。使用 MNA 和生化标志物等工具的更个性化方法可能会有所帮助。需要进一步的研究来验证这些发现并为临床干预提供信息。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe1/11467083/ea7ed80f97bd/11739_2024_3709_Fig1_HTML.jpg

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