平均肝脏密度可独立预测原发性胆汁性胆管炎患者的治疗反应及肝脏相关死亡率。
Mean liver density independently predicts therapeutic response and liver-related mortality in patients with primary biliary cholangitis.
作者信息
Wang Zilong, Yang Shuo, Zhong Juan, Liu Xinyue, Feng Jiajun, Jin Qian, Ren Wenhui, Wang Jian, Ma Danli, Rao Huiying, Huang Rui
机构信息
Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China.
Department of Radiology, Peking University People's Hospital, Beijing, China.
出版信息
Quant Imaging Med Surg. 2024 Dec 5;14(12):9074-9085. doi: 10.21037/qims-24-553. Epub 2024 Nov 29.
BACKGROUND
Sarcopenia, myosteatosis, and sarcopenic obesity are known to adversely affect nutritional status and quality of life in cirrhotic patients. However, there is limited research on these conditions in individuals with primary biliary cholangitis (PBC). This study aims to identify risk factors for sarcopenia, myosteatosis, and sarcopenic obesity in PBC patients and to investigate their association with therapeutic outcomes and liver-related mortality. Furthermore, this research aims to uncover novel imaging-based risk factors that may influence biochemical response rates and mortality risk.
METHODS
In this retrospective study, patients with PBC were enrolled. Sarcopenia and myosteatosis were defined using the third lumbar vertebra (L3) skeletal muscle index (SMI) and skeletal muscle density (SMD) obtained from computed tomography (CT) imaging. The prognosis of PBC patients can be accurately evaluated using the PARIS I criteria.
RESULTS
The study included 117 PBC patients, of whom 73 (62.4%) exhibited sarcopenia and 51 (43.6%) presented with myosteatosis. Seventeen (14.5%) patients were with sarcopenic obesity. The rate of biochemical response was 38.5%. During a mean follow-up period of 68 months, seven patients died. Patients with sarcopenia were older, with a lower body mass index (BMI) and a higher prevalence of myosteatosis, as well as lower visceral adipose tissue index (VATI) and subcutaneous adipose tissue index (SATI) levels (P<0.05). Patients with myosteatosis were older and had higher levels of albumin, SATI, and VATI (P<0.05). They also had a higher prevalence of sarcopenia and sarcopenia obesity (P<0.05). Multivariate analysis revealed that neither sarcopenia nor myosteatosis impacted the biochemical response rates or liver-related mortality in PBC patients. Conversely, mean liver density was identified as a significant risk factor for biochemical response and liver-related mortality (P<0.05).
CONCLUSIONS
Mean liver density is an independent predictor for biochemical response and liver-related mortality in patients with PBC.
背景
已知肌肉减少症、肌少脂性肥胖会对肝硬化患者的营养状况和生活质量产生不利影响。然而，关于原发性胆汁性胆管炎（PBC）患者这些情况的研究有限。本研究旨在确定PBC患者肌肉减少症、肌少脂性肥胖的危险因素，并调查它们与治疗效果和肝脏相关死亡率的关联。此外，本研究旨在发现可能影响生化反应率和死亡风险的基于影像学的新危险因素。
方法
在这项回顾性研究中，纳入了PBC患者。使用从计算机断层扫描（CT）成像获得的第三腰椎（L3）骨骼肌指数（SMI）和骨骼肌密度（SMD）来定义肌肉减少症和肌少脂性肥胖。PBC患者的预后可使用PARIS I标准进行准确评估。
结果
该研究纳入了117例PBC患者，其中73例（62.4%）表现出肌肉减少症，51例（43.6%）存在肌少脂性肥胖。17例（14.5%）患者为肌少脂性肥胖。生化反应率为38.5%。在平均68个月的随访期内，7例患者死亡。肌肉减少症患者年龄较大，体重指数（BMI）较低，肌少脂性肥胖患病率较高，内脏脂肪组织指数（VATI）和皮下脂肪组织指数（SATI）水平较低（P<0.05）。肌少脂性肥胖患者年龄较大，白蛋白、SATI和VATI水平较高（P<0.05）。他们的肌肉减少症和肌少脂性肥胖患病率也较高（P<0.05）。多变量分析显示，肌肉减少症和肌少脂性肥胖均未影响PBC患者的生化反应率或肝脏相关死亡率。相反，平均肝脏密度被确定为生化反应和肝脏相关死亡率的重要危险因素（P<0.05）。
结论
平均肝脏密度是PBC患者生化反应和肝脏相关死亡率的独立预测因素。
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