背景:关于肝硬化的新证据表明身体成分异常与不良预后密切相关。本研究旨在评估身体成分动态变化对肝硬化患者预后结果的影响。
方法:这项回顾性分析包括2018年1月至2023年8月诊断为肝硬化的158例患者。骨骼肌质量,肌肉质量,在第三腰椎水平使用计算机断层扫描(CT)成像评估内脏和皮下肥胖。竞争风险模型进行了四种不同的身体成分状态(即,正常,只有少肌症,只有肌肉骨化,和联合状态)与肝脏相关的死亡率。我们还通过应用Gray检验探讨了身体成分的动态变化与长期预后之间的关系。
结果:在158例肝硬化患者中(平均[SD]年龄,57.1[12.6]年),85例(60.1%)患者存在肌肉减少症,22例(13.9%)患者患有肌少症性肥胖,68例(43.0%)患者患有肌萎缩症。与身体成分正常的患者相比,仅被诊断患有肌肉减少症的患者表现出更高的死亡率(Gray\'stest,P=0.006),而仅诊断为肌骨化病或伴有肌肉减少症和肌骨化病的患者没有达到统计学意义(Gray\'s检验,P=0.076;P=0.140)。多变量分析还显示,VSR(HR=1.10[1.01~1.20];P=0.028),肌肉减少症(HR=2.73[1.20~6.22],P=0.017)和肌肉骨化(HR=2.39[1.10~5.18],P=0.028)是肝脏相关死亡的显著独立预测因子。否则,在随访期间身体成分加重的患者与身体成分正常或缓解的患者相比,死亡风险显著较高(HR=7.63[1.12~51.14];P=0.036).
结论:在肝硬化患者中,身体成分状态的进行性改变似乎与肝脏相关死亡率相关。专注于骨骼肌的管理,还有内脏和皮下脂肪,可能有助于改善肝硬化患者的预后。
BACKGROUND: Emerging evidence on cirrhosis suggests a close correlation between abnormality in body composition characteristics and poor prognosis. This study aimed to evaluate the impact of dynamic changes in body composition on the prognostic outcomes in patients with cirrhosis.
METHODS: This retrospective analysis included 158 patients diagnosed as cirrhosis from January 2018 to August 2023. Skeletal muscle mass, muscle quality, visceral and subcutaneous adiposity were evaluated using computed tomography (CT) imaging at the third lumbar vertebra level. Competing risk model was performed four different body composition status (i.e., normal, only sarcopenia, only
myosteatosis, and combined status) for liver-related mortality. We also explored the relationship between the dynamic change in body composition and long-term prognosis by applying Gray\'s test.
RESULTS: Of the 158 cirrhotic patients (mean [SD] age, 57.1 [12.6] years), sarcopenia was present in 85 (60.1 %) patients, while 22 (13.9 %) patients had sarcopenic obesity and 68 (43.0 %) had
myosteatosis. Patients solely diagnosed with sarcopenia exhibited a higher mortality rate compared to those with normal body composition (Gray\'s test, P=0.006), while patients solely diagnosed with
myosteatosis or with a combination of sarcopenia and
myosteatosis did not reach statistical significance (Gray\'s test, P=0.076; P=0.140). Multivariable analysis also revealed that VSR (HR=1.10 [1.01∼1.20]; P=0.028), sarcopenia (HR=2.73 [1.20∼6.22], P=0.017) and
myosteatosis (HR=2.39 [1.10∼5.18], P=0.028) were significant independent predictors of liver-related deaths. Otherwise, patients exhibiting aggravating body composition during follow-up period were associated with a significantly higher mortality risk compared to those with normal or remission body composition status (HR=7.63 [1.12∼51.14]; P=0.036).
CONCLUSIONS: Progressive alterations in body composition status appears to be associated with liver-related mortality in individuals with liver cirrhosis. Focusing on the management of skeletal muscle, along with visceral and subcutaneous adiposity, may contribute to improving the prognosis of cirrhotic patients.