■激素变化和肝性骨营养不良是肝硬化并发症的研究较少。这项研究描述了虚弱和不虚弱的肝硬化患者之间激素和骨营养不良的差异。
■116例肝硬化门诊患者前瞻性纳入本研究。使用肝脏虚弱指数(LFI)进行虚弱评估。社会人口统计学评估,人体测量学,营养评估,激素谱,所有患者均进行双能X线骨密度仪扫描。
■116名患者,主要包括男性(100人(86.2%),平均年龄50.16岁(95%CI,48.43-51.89).与不虚弱组相比,虚弱组营养不良更常见。主观总体评估(SGA)B级患者在脆弱组中明显更多(37(74%)vs3(4.5%),P=0.001)。低甲状旁腺激素(PTH)的患病率(14(28%)vs2(3%)),睾酮(33(66%)对15(22.7%)),维生素D3(44(88%)对39(59.1%)),虚弱组皮质醇(37(74%)vs37(56.1)水平较高(P<0.05)。诊断为骨营养不良的患者人数(34(68%)vs21(31.8%),P=0.001)在脆弱组明显更高。破骨细胞活动的标志,β-交叉圈数,在脆弱组中,男性(736(655-818)vs380(329-432)均显着升高,P=0.001)和(女性619(479-758)vs313(83-543),P=0.02)。腰椎(LS)和股骨颈(NF)的骨密度(BMD)与LFI显着相关(ρ=0.60,LS为P=0.001,ρ=0.59,NF为P=0.001)。血清睾酮(LSρ=0.58,P=0.001,NFρ=0.53,P=0.001),β-交叉圈数(ρ=0.38,LS为P=0.001,NF为ρ=0.35,P=0.000),维生素D3(LSρ=0.23,P=0.04,NFρ=0.25,P=0.01),PTH(ρ=0.52,LS的P=0.001,ρ=0.48。NF的P=0.001),和皮质醇(LS为ρ=0.50,P=0.001,NF为ρ=0.45,P=0.001)水平。
■这是第一项研究,强调了激素变化和肝性骨营养不良在肝硬化虚弱患者中的高患病率,并为该领域的研究和治疗目标开辟了新的领域。
UNASSIGNED: Hormonal changes and hepatic osteodystrophy are less often studied complications of cirrhosis. This study describes the variance in hormones and osteodystrophy between Frail and Not frail patients with cirrhosis.
UNASSIGNED: 116 outpatients with cirrhosis were prospectively enrolled in this study. Frailty assessment was done using Liver Frailty Index (LFI). Sociodemographic assessment, anthropometry, nutritional assessment, hormone profile, and dual-energy X-ray absorptiometry scan were done in all patients.
UNASSIGNED: 116 patients, predominantly males (100 (86.2%) with mean age of 50.16 years (95% CI, 48.43-51.89) were included. Malnutrition was more common in Frail group as compared to Not frail group. Subjective global assessment (SGA) class-B patients were significantly more in Frail group (37 (74%) vs 3 (4.5%), P = 0.001). The prevalence of lower parathyroid hormone (PTH) (14 (28%) vs 2 (3%)), testosterone (33 (66%) vs 15 (22.7%)), vitamin D3 (44 (88%) vs 39 (59.1%)), and cortisol (37 (74%) vs 37 (56.1) levels was higher in Frail group (P < 0.05). The number of patients diagnosed with osteodystrophy (34 (68%) vs 21 (31.8%), P = 0.001) was significantly higher in Frail group. The marker of osteoclastic activity, β-cross laps, was significantly elevated in the Frail group both in males (736 (655-818) vs 380 (329-432), P = 0.001) and (females 619 (479-758) vs 313 (83-543), P = 0.02). Bone mineral density (BMD) at lumbar spine (LS) and neck of femur (NF) had significant correlation with LFI (ρ = 0.60, P = 0.001 for LS and ρ = 0.59, P = 0.001 for NF), serum testosterone (ρ = 0.58, P = 0.001 for LS and ρ = 0.53, P = 0.001 for NF), β-cross laps (ρ = 0.38, P = 0.001for LS and ρ = 0.35, P = 0.000 for NF), vitamin D3 (ρ = 0.23, P = 0.04 for LS and ρ = 0.25, P = 0.01 for NF), PTH (ρ = 0.52, P = 0.001 for LS and ρ = 0.48. P = 0.001 for NF), and cortisol (ρ = 0.50, P = 0.001 for LS and ρ = 0.45, P = 0.001 for NF) levels.
UNASSIGNED: This is the first study that highlights the high prevalence of hormonal changes and hepatic osteodystrophy in frail patients with cirrhosis and opens a new dimension for research and target of therapy in this field.