背景:在有限的研究中评估了肝硬化患者的肌萎缩症,结果相互矛盾,在这种情况下没有进行系统评价或荟萃分析。
方法:我们搜索了直到2023年6月发表的所有文章,以评估肝硬化和慢性肝病中肌萎缩的患病率。
结果:包括17项针对肝硬化的研究和5项针对慢性肝病患者的研究:肌肉骨化的总体合并患病率为46%[95%置信区间(CI)36-57%]和33%(95%CI15-59%),分别(p=0.35)。在肝硬化的研究中,使用基于体重指数的肌骨形成定义的人的肌骨形成率较高(56%),高于基于性别(36%)或其他标准(21%)(p<0.01);女性高于男性(61%vs45%),Child-PughC级比A或B级(57%对49%对50%),在非酒精性脂肪性肝病(NAFLD)-比病毒相关的肝硬化(57%vs43%),但差异无统计学意义(p>0.05)。肝硬化患者伴有肌浆化,与那些没有肌肉骨化的人相比,以前有肝性脑病史的频率更高(32%vs15%,p=0.04),既往静脉曲张出血病史较少(46%vs65%,p<0.01),更容易患糖尿病(27%vs18%,p<0.01),虽然他们的死亡率更高(40%对14%,p=0.02)。
结论:肌萎缩在肝硬化患者中非常普遍,特别是那些与NAFLD相关的肝硬化。肌萎缩与肝性脑病有关,虽然这似乎对结果有负面影响。
BACKGROUND: Myosteatosis in cirrhotic patients has been evaluated in limited studies with conflicting results and no systematic
review or meta-analysis have been performed in this setting.
METHODS: We searched for all articles published until June 2023 to evaluate the prevalence of myosteatosis in cirrhosis and chronic liver disease.
RESULTS: Seventeen studies focused on cirrhosis and five studies in patients with chronic liver disease were included: the overall pooled prevalence of myosteatosis was 46% [95% Confidence Interval (CI) 36-57%] and 33% (95% CI 15-59%), respectively (p = 0.35). Among the studies with cirrhosis, the prevalence of myosteatosis was higher in those using the body mass index-based definition of myosteatosis (56%), than gender-based (36%) or other criteria (21%) (p < 0.01); was higher in women than in men (61% vs 45%), in Child-Pugh class C than A or B (57% vs 49% vs 50%), in non-alcoholic fatty liver disease (NAFLD)- than viral-associated cirrhosis (57% vs 43%), but these differences were not statistically significant (p > 0.05). Cirrhotic patients with myosteatosis, compared to those without myosteatosis, had more frequently a previous history of hepatic encephalopathy (32% vs 15%, p = 0.04), less frequently a previous history of variceal bleeding (46% vs 65%, p < 0.01), were more likely to suffer from diabetes mellitus (27% vs 18%, p < 0.01), while they had higher mortality rates (40% vs 14%, p = 0.02).
CONCLUSIONS: Myosteatosis is highly prevalent in patients with cirrhosis, particularly in those with NAFLD-associated cirrhosis. Myosteatosis is associated with hepatic encephalopathy, while it seems to have a negative impact on the outcome.