肝硬化患者肌肉减少症及其体脂肪水平的观察性研究  

An observational study of sarcopenia and body fat level in cirrhotic patients

作　　者：韩明 姜祺澜 苏文意 邓明明 罗刚 汪敏 Han Ming;Jiang Qilan;Su Wenyi;Deng Mingming;Luo Gang;Wang Min(Department of Clinical Nutrition,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Gastroenterology,Affiliated Hospital of Southwest Medical University,Luzhou 646099,Sichuan,China;Key Laboratory of Haemodynamics in Medical-Industrial Integration of Luzhou,Luzhou 646000,Sichuan,China)

机构地区：[1]西南医科大学附属医院临床营养科,四川泸州646000 [2]西南医科大学附属医院消化内科,四川泸州646099 [3]血流动力学医工结合泸州重点实验室,四川泸州646000

出　　处：《肿瘤代谢与营养电子杂志》2024年第5期677-682,共6页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：四川省科技计划项目(2022YFS0626)。

摘　　要：目的分析肝硬化患者中肌肉和体脂肪水平,探讨肝病严重程度与肝硬化患者肌肉和体脂肪的关系。方法采用横断面研究方法收集2022年11月至2023年11月在西南医科大学附属医院住院的肝硬化患者指标,利用Sliceomatic 5.0图像分析软件测量腹部计算机断层扫描(CT)在第3腰椎水平的骨骼肌指数(L3-SMI)、内脏脂肪面积(VFA)和皮下脂肪面积(SFA),评估老年营养风险指数(GNRI)。VFA和SFA分别与L3-SMI、三头肌皮褶厚度(TSF)、非优势侧上臂中点围度(MAC)等指标进行相关性分析,比较不同Child-Pugh分级和终末期肝病模型(MELD)评分的分组中CT所测得的肌肉和体脂肪水平。结果共纳入203例肝硬化患者,其中合并肌肉减少症患者86例(42.4%),非肌肉减少症患者117例(57.6%),肝硬化合并肌肉减少症患者的体质指数(BMI)、手握力(HS)、MAC、TSF、小腿围(CC)、VFA、SFA、内脏脂肪指数(VATI)及皮下脂肪指数(SATI)低于非肌肉减少症患者(P<0.05),VFA与MAC的相关性最强(r=0.595,P<0.001),SFA与TSF相关性最强(r=0.753,P<0.001)。Child-Pugh评分C级的VFA、SFA、VATI和SATI低于Child-Pugh评分A级与B级(P<0.05),L3-SMI组间比较无统计学差异;MELD评分>11分的上述指标均低于MELD评分≤11分(P<0.05),L3-SMI组间比较无统计学差异。结论肝硬化患者发生肌肉减少症时,体脂肪水平也下降,且随疾病严重程度的增加而下降,但肌肉水平未见显著变化。Objective To analyze muscle and body fat levels in cirrhotic patients,as well as investigate the association between liver disease severity and muscle and body fat in patients with cirrhosis.Method All study participants were cirrhosis patients who were hospitalized at Southwest Medical University's Affiliated Hospital from November 2022 to November 2023.A cross-sectional study was used to collect data on cirrhotic patients'general condition,blood routine,biochemical tests,anthropometric measurements,etc.Measurement of skeletal muscle index(L_(3)-SMI),visceral fat area(VFA),and subcutaneous fat area(SFA)of abdominal CT at the level of the 3rd lumbar vertebrae using Sliceomatic 5.0 image analysis software.The Geriatric Nutritional Risk Index(GNRI)was analyzed.VFA and SFA were correlated with L3-SMI,triceps skinfold thickness(TSF),and mid-arm circumference(MAC),respectively.To compare the levels of body fat and muscle measured by CT in subgroups with different Child-Pugh classifications and MELD scores.Result A total of 203 patients with liver cirrhosis were included,86 patients with sarcopenia(42.4%),and 117 patients with non-sarcopenia(57.6%).Body mass index(BMI),hand grip strength(HS),MAC,TSF,calf circumference(CC),VFA,SFA,visceral adiposity index(VATI),and subcutaneous adiposity index(SATI)were lower in patients with cirrhosis combined with sarcopenia than in patients with non-sarcopenia(P<0.05).VFA correlating most strongly with MAC(r=0.595,P<0.001)and SFA correlating most strongly with TSF(r=0.753,P<0.001).Child-Pugh score grade C had lower VFA,SFA,VATI,and SATI than Child-Pugh score grade A versus B(P<0.05),L_3-SMI was not statistically different between groups,and all of the above indicators were lower in the MELD score>11 subgroup than in the MELD score≤11 subgroup(P<0.05),and L_3-SMI was again not statistically different between groups.Conclusion When sarcopenia occurred in patients with cirrhosis,body fat levels also decreased and decreased with increasing disease severity,but no significant changes in

关 键 词：肝硬化 肌肉减少症 内脏脂肪面积 皮下脂肪面积 内脏脂肪组织指数 皮下脂肪组织指数 肱三头肌皮褶厚度 上臂中点维度 

分 类 号：R575.2[医药卫生—消化系统] R685[医药卫生—内科学]