Levers Alena, Pantke Judith, Klimeš Filip, Lenzen Henrike, Düx Daniel, Taubert Richard, Wedemeyer Heiner, Wacker Frank, Ringe Kristina I
Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany.
European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.
Liver Int. 2025 Oct;45(10):e70328. doi: 10.1111/liv.70328.
We aimed to ascertain the prevalence of sarcopenia in patients with primary sclerosing cholangitis (PSC) and to assess the prognostic value as a biomarker for disease outcome.
We collected data from 224 patients (148 male, 76 female; mean age 41 years) from January 2002 to December 2021, with a confirmed diagnosis of PSC who underwent magnetic resonance imaging (MRI). Muscle mass was quantified at the level of the third lumbar vertebra by measurement of psoas muscle thickness (PMT) and total psoas muscle area (PMA). Sarcopenia was defined according to previously published cut-off values. Muscle mass and the prevalence of sarcopenia were correlated with patient and disease characteristics, prognostic scoring systems (model for end-stage liver disease (MELD) score; Mayo Risk Score; Amsterdam-Oxford PSC Score) and clinical endpoints (liver transplantation, cirrhosis decompensation, liver-related death).
Seventy-eight patients reached a total of 104 clinical endpoints (liver transplantation n = 57, cirrhosis decompensation n = 28, liver-related death n = 19). Sarcopenia was prevalent in 27.7% and 51.3%, respectively (according to the definition of PMT and PMA). Sarcopenia was significantly more prevalent in female patients and in patients without IBD (p < 0.05). A slight but significant negative correlation of muscle mass was noticed with the MELD (r = -0.244, p = 0.001) and Mayo Risk Score (r = -0.13, p = 0.046). At follow-up, sarcopenia was associated with an inferior liver-related event-free survival (p < 0.05).
Sarcopenia is highly prevalent in a large PSC cohort from a tertiary care centre, even more frequent in female patients and in patients without concomitant IBD. Furthermore, the presence of sarcopenia in PSC patients is associated with an inferior liver-related event-free survival.
我们旨在确定原发性硬化性胆管炎（PSC）患者中肌肉减少症的患病率，并评估其作为疾病预后生物标志物的预后价值。
我们收集了2002年1月至2021年12月期间224例确诊为PSC且接受了磁共振成像（MRI）检查的患者的数据（148例男性，76例女性；平均年龄41岁）。通过测量腰大肌厚度（PMT）和腰大肌总面积（PMA）在第三腰椎水平对肌肉量进行量化。肌肉减少症根据先前公布的临界值进行定义。肌肉量和肌肉减少症的患病率与患者及疾病特征、预后评分系统（终末期肝病模型（MELD）评分；梅奥风险评分；阿姆斯特丹-牛津PSC评分）以及临床终点（肝移植、肝硬化失代偿、肝病相关死亡）相关。
78例患者共出现104个临床终点（肝移植57例，肝硬化失代偿28例，肝病相关死亡19例）。根据PMT和PMA的定义，肌肉减少症的患病率分别为27.7%和51.3%。女性患者和无炎症性肠病（IBD）的患者中肌肉减少症更为普遍（p<0.05）。肌肉量与MELD（r=-0.244，p=0.001）和梅奥风险评分（r=-0.13，p=0.046）之间存在轻微但显著的负相关。随访时，肌肉减少症与较差的肝病相关无事件生存率相关（p<0.05）。
在一家三级医疗中心的大型PSC队列中，肌肉减少症非常普遍，在女性患者和无合并IBD的患者中更为常见。此外，PSC患者中肌肉减少症的存在与较差的肝病相关无事件生存率相关。
