Wongtrakul Wasit, Bandidniyamanon Wimolrak, Charatcharoenwitthaya Phunchai
Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BMC Gastroenterol. 2025 Feb 17;25(1):88. doi: 10.1186/s12876-025-03674-9.
Sarcopenia, characterized by loss of muscle mass and function, has gained importance in the evaluation of cirrhotic patients. Evidence suggests its role in adverse clinical outcomes, including minimal hepatic encephalopathy (MHE). This study aimed to investigate the association between sarcopenia and MHE in patients with cirrhosis.
We prospectively enrolled outpatients with cirrhosis to assess sarcopenia using the 2019 criteria from the Asian Working Group for Sarcopenia. MHE was diagnosed through the Psychometric Hepatic Encephalopathy Score.
Of the 210 cirrhotic patients (57.1% male, mean age 62.7 ± 9.6 years), 54 (25.7%) had sarcopenia, with 26 (12.3%) classified as severe. Thirty-seven patients (17.6%) were diagnosed with MHE. Sarcopenia prevalence was significantly higher in patients with MHE compared to those without MHE (45.9% vs. 21.4%). MHE was significantly associated with age, education level, Mini-Mental State Examination score, and a history of hepatic decompensation. No significant associations were found regarding gender, body mass index, comorbidities, sleep quality, and the etiology of cirrhosis. Multivariable logistic regression showed that MHE was significantly associated with age (adjusted odds ratio [aOR] 1.08, 95% CI 1.02-1.13), sarcopenia (aOR 3.29, 95% CI 1.44-7.50), history of overt hepatic encephalopathy (aOR 7.40, 95% CI 1.20-45.56), and variceal bleeding (aOR 3.13, 95% CI 1.38-7.10). Severe sarcopenia was also independently associated with MHE (aOR 3.64, 95% CI 1.32-10.05).
Sarcopenia is prevalent in cirrhotic patients and is associated with an increased risk of MHE. Our findings emphasize the importance of assessing sarcopenia to potentially mitigate MHE risk in managing patients with cirrhosis.
肌肉减少症以肌肉质量和功能丧失为特征，在肝硬化患者的评估中日益受到重视。有证据表明其在不良临床结局中起作用，包括轻微肝性脑病（MHE）。本研究旨在调查肝硬化患者中肌肉减少症与MHE之间的关联。
我们前瞻性纳入肝硬化门诊患者，使用亚洲肌肉减少症工作组2019年的标准评估肌肉减少症。通过心理测量肝性脑病评分诊断MHE。
在210例肝硬化患者中（男性占57.1%，平均年龄62.7±9.6岁），54例（25.7%）有肌肉减少症，其中26例（12.3%）为重度。37例患者（17.6%）被诊断为MHE。与无MHE的患者相比，MHE患者的肌肉减少症患病率显著更高（45.9%对21.4%）。MHE与年龄、教育水平、简易精神状态检查表评分以及肝失代偿病史显著相关。在性别、体重指数、合并症、睡眠质量和肝硬化病因方面未发现显著关联。多变量逻辑回归显示，MHE与年龄（调整优势比[aOR]1.08，95%可信区间1.02 - 1.13）、肌肉减少症（aOR 3.29，95%可信区间1.44 - 7.50）、显性肝性脑病病史（aOR 7.40，95%可信区间1.20 - 45.56）和静脉曲张出血（aOR 3.13，95%可信区间1.38 - 7.10）显著相关。重度肌肉减少症也与MHE独立相关（aOR 3.64，95%可信区间1.32 - 10.05）。
肌肉减少症在肝硬化患者中普遍存在，且与MHE风险增加相关。我们的研究结果强调了评估肌肉减少症对于潜在降低肝硬化患者MHE风险的重要性。
