Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin, 300052, China.
Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, East Street 6, Tianjin Airport Economic Area, Tianjin, 300308, China.
Health Qual Life Outcomes. 2024 Sep 12;22(1):78. doi: 10.1186/s12955-024-02295-2.
There is a paucity of data regarding sex-oriented analyses of connection between muscle quantity and quality and health-related quality of life (HRQoL), taking into account the pathophysiological differences of sarcopenia/myosteatosis in males versus females. We sought to investigate the associations between skeletal muscle index (SMI)-defined sarcopenia and intramuscular adipose tissue content (IMAC)-defined myosteatosis and EuroQol-5D (EQ-5D)-defined HRQoL in patients with decompensated cirrhosis concerning sex disparities.
Totally, 382 patients were enrolled. The relationship between SMI/IMAC and HRQoL was evaluated with restricted cubic spline and Pearson correlation analyses. Furthermore, association between SMI or sarcopenia and EQ-5D utility index was determined by multiple linear regression, adjusted for age, BMI and concurrent disease severity.
The study population comprised evenly distributed male and female patients (190: 192), mean age 61.9 years. The prevalence of sarcopenia (40.5 versus 9.9%, P < 0.001) and SMI (48.8 versus 42.2 cm/m, P < 0.001) were significantly higher in males relative to females, with comparable myosteatosis prevalence (15.3 versus 16.7%, P = 0.708). Self-care, usual activities and pain within EQ-5D scale were more prevalent in the sarcopenia compared with non-sarcopenia groups across entire population and stratified by sex. The SMI values exhibited a significantly linear correlation with EQ-5D utility index in male but not female patients (P for non-linearity = 0.281). In multiple analysis, SMI or the presence of sarcopenia was both significantly associated with EQ-5D utility index. Subgroup analyses unveiled no discernible interactions between sarcopenia and EQ-5D utility index.
Muscle quantity measured by SMI was associated with declined HRQoL in males rather than females, whereas no associations were found regarding muscle quality measured by IMAC in both sexes. It is tempting to manage sarcopenia by increasing SMI levels as high as possible in hopes of achieving better health consequence. Our findings represent the importance of connecting CT-demarcated body composition abnormalities to meaningful patient-centered outcomes. Future targeted studies with sizable multi-center populations are warranted to clarify this causality, and in consequence develop optimized intervention against sarcopenia/myosteatosis or key determinants concerning impaired HRQoL.
目前，关于肌肉量和质与健康相关生活质量（HRQoL）之间的关联，考虑到男性和女性中肌少症/肌内脂肪增多症的病理生理学差异，很少有针对性别分析的研究数据。我们旨在调查在代偿性肝硬化患者中，基于骨骼肌指数（SMI）定义的肌少症和基于肌肉内脂肪组织含量（IMAC）定义的肌内脂肪增多症与 EQ-5D（EQ-5D）定义的 HRQoL 之间的关联，同时考虑到性别差异。
共纳入 382 名患者。采用限制性立方样条和 Pearson 相关分析评估 SMI/IMAC 与 HRQoL 之间的关系。此外，通过多元线性回归分析，调整年龄、BMI 和并存疾病严重程度，确定 SMI 或肌少症与 EQ-5D 效用指数之间的关联。
研究人群中男性和女性患者分布均匀（190:192），平均年龄为 61.9 岁。男性患者肌少症（40.5%比 9.9%，P<0.001）和 SMI（48.8cm/m 比 42.2cm/m，P<0.001）的患病率明显高于女性，而肌内脂肪增多症的患病率相似（15.3%比 16.7%，P=0.708）。在整个人群和按性别分层的情况下，EQ-5D 量表中的自我护理、日常活动和疼痛在肌少症组比非肌少症组更常见。在男性患者中，SMI 值与 EQ-5D 效用指数呈显著线性相关，但在女性患者中则无（非线性 P 值=0.281）。在多元分析中，SMI 或肌少症的存在均与 EQ-5D 效用指数显著相关。亚组分析显示，肌少症与 EQ-5D 效用指数之间无明显交互作用。
在男性中，通过 SMI 测量的肌肉量与 HRQoL 下降有关，而在女性中，通过 IMAC 测量的肌肉质量与 HRQoL 无关。通过尽可能提高 SMI 水平来治疗肌少症以获得更好的健康结果是很有吸引力的。我们的研究结果表明，将 CT 界定的身体成分异常与有意义的以患者为中心的结局联系起来的重要性。未来需要有更大规模的多中心人群的靶向研究来阐明这种因果关系，并相应地制定针对肌少症/肌内脂肪增多症或影响 HRQoL 的关键决定因素的优化干预措施。
