肝硬化合并肌肉减少症的危险因素及其对临床结局的影响

目的研究肌肉减少症在肝硬化患者中的发生情况,探讨其危险因素及其对临床结局的影响。方法收集肝硬化住院患者199例,进行营养风险筛查、人体测量、血生物化学检查,根据体成分分析测得的四肢骨骼肌含量计算骨骼肌质量指数(ASMI),将患者分为肌肉减少症组和无肌肉减少症组,比较两组相关指标,筛选影响肌肉减少症发生的因素;随访48个月,比较两组生存、并发症发生情况。据资料不同分别采用t检验、χ2检验、Logistic回归分析进行统计学分析。结果肌肉减少症在肝硬化中的发生率为36.7%,在并发肝性脑病患者中最为多见(62.5%),其次是并发腹/胸水患者(37.6%)。有营养风险者肌肉减少症发生率明显高于无营养风险者(P<0.05),即使无营养风险者也有14.8%合并肌肉减少症。肌肉减少症组体质量指数(BMI)、上臂肌围、身体细胞量低于无肌肉减少症组(P<0.05),浮肿指数(ECW/TBW)高于后者(P<0.05)。多因素分析结果显示,年龄、性别、BMI、并发症肝性脑病是肝硬化合并肌肉减少症的主要影响因素(P<0.05)。随访期间肌肉减少症组病死率高于无肌肉减少症者(P<0.05),反复腹/胸水、肝性脑病、感染的发生率亦明显升高(P<0.05)。结论肌肉减少症是肝硬化患者营养不良的表现之一,使患者病死率、发生其他并发症的风险升高,对临床结局产生不良影响。老年、男性患者、BMI越低、并发肝性脑病,肌肉减少症发生风险越高。

Risk factors of cirrhosis combined with sarcopenia and their impact on clinical outcomes

Objective To study the occurrence of sarcopenia in patients with liver cirrhosis,and to explore their risk factors and impact on clinical outcomes.Methods 199 hospitalized cases with liver cirrhosis were collected for nutritional risk screening,anthropometric measurement and blood biochemical examination.The body composition analysis was measured based on the skeletal muscle content of the four limbs to calculate the appendicular skeletal muscle mass index(ASMI).Patients were divided into sarcopenia and non-sarcopenia group and the relevant indexes of both groups were compared to screen for factors affecting the occurrence of sarcopenia.During the follow-up of 48 months,the survival and complications of the both groups were compared.Statistical analysis was performed using t-test,χ2 test and logistic regression analysis in terms of different data.Results The incidence of sarcopenia in cirrhosis was 36.7%,with the highest prevalence in patients with recurrent hepatic encephalopathy(62.5%),followed by patients with abdominal ascites/pleural effusion(37.6%).The incidence of sarcopenia was significantly higher in those with nutritional risk than in those without nutritional risk(P<0.05).However,even among those without nutritional risk,14.8%had combined sarcopenia.The body mass index(BMI),upper arm muscle circumference(AMC),and body cell mass(BCM)of the sarcopenia group were lower than those of the non-sarcopenia group(P<0.05),and the edema index(ECW/TBW)was higher than the latter(P<0.05).Multivariate analysis showed that age,gender,BMI,and complications of hepatic encephalopathy were the main influencing factors of cirrhosis combined with sarcopenia(P<0.05).During the follow-up period,the sarcopenia group had a higher mortality rate than non-sarcopenia goup(P<0.05),and the incidence of recurrent abdominal ascites/pleural effusion,hepatic encephalopathy,and infection was also significantly elevated(P<0.05).Conclusion Sarcopenia is one of the manifestations of malnutrition in patients with liver cirrhosis,which increases the risk of mortality and other complications,and has adverse impact on the clinical outcome.Additionally,older age,male sex,low BMI and recurrent hepatic encephalopathy has higher risk for developing sarcopenia.