乙型肝炎病毒感染后肝硬化患者肌肉减少与肝性脑病的相关性分析

Correlation analysis of sarcopenia and hepatic encephalopathy in patients with hepatitis B cirrhosis

目的探讨肌肉减少症及肌肉减少性肥胖对失代偿期乙肝肝硬化患者发生轻微肝性脑病(MHE)和显性肝性脑病(OHE)的影响。方法收集2015年1月至2017年12月连续收治的失代偿期乙肝肝硬化患者相关资料,以肝性脑病评分量表(PHES)诊断MHE,以脐平面CT图像中右侧腰大肌最大横径/身高(TPMT/H)和肌肉衰减指数(SM-RA)评价肌肉减少症及肌肉减少性肥胖。分别采用Logistic回归分析和Cox生存分析回顾性分析肝硬化患者MHE和OHE发生的危险因素。结果MHE组血氨高于N-MHE组[(62.19±22.20)μmol比(50.00±21.53)μmol/L],MHE组年龄高于N-MHE组[(55.25±10.5)岁比(50.67±10.7)岁],而TPMT/H和SM-RA均低于N-MHE组,[(16.63±3.07)mm/m比(18.15±3.41)mm/m,(38.46±5.96)Hu比(42.00±5.69)Hu],组间比较差异均有统计学意义(P均<0.05)。Logistic回归分析证实,血氨、TPMT/H和SM-RA是患者住院期间发生MHE的独立危险因素(OR:1.625,95%CI:1.150~2.297,P=0.006;OR:0.748,95%CI:0.628~0.893,P=0.001;OR:0.779,95%CI:0.687~0.882,P=0.001)。Cox生存分析结果显示,SM-RA是患者在随访期间OHE发生的独立危险因素(HR:0.889,95%CI:0.837~0.943,P<0.01)。结论肌肉减少症和肌肉减少性肥胖不仅与失代偿期乙肝肝硬化发生MHE有关,同时还是中远期发生OHE的危险因素,因此改善患者蛋白营养状况,可能降低MHE及OHE发生率。

Objective To explore the impact of sarcopenia and myosteatosis on minimal hepatic encephalopathy(MHE)and overt hepatic encephalopathy(OHE)in patients with hepatitis B-related decompensated cirrhosis.Methods Data of patients with decompensated hepatitis B cirrhosis were collected from January 2015 to December 2017.MHE was diagnosed by psychometric hepatic encephalopathy score(PHES),and sarcopenia and obesity were evaluated by transverse psoas muscle thickness/height(TPMT/H)and skeletal muscle radiation attenuation(SM-RA)of the right psoas major muscle in the CT images at umbilical level.The risk factors of MHE and OHE in cirrhotic patients were analyzed retrospectively by Logistic regression analysis and Cox survival analysis.Results Compared to patients in N-MHE Group,patients in MHE group had significantly higher blood ammonia levels[(62.19±22.20)μmol/L vs.(50.00±21.53)μmol/L],older age[(55.25±10.46)years vs.(50.67±10.73)years],but lower T/H and SM/RA of PMT[(16.63±3.07)mm/m vs.(18.15±3.41)mm/m and(38.46±5.96)Hu ratio(42.00±5.69)Hu,respectively](P<0.05 for all comparisons).Logistic regression analysis confirmed that blood ammonia,TPMT/H and SM-RA were independent risk factors for MHE during hospitalization(OR:1.625,95%CI:1.150-2.297,P=0.006;OR:0.748,95%CI:0.628-0.893,P=0.001;OR:0.779,95%CI:0.687-0.882,P=0.001).Cox survival analysis showed that SM-RA was an independent risk factor for OHE occurrence during follow-up(HR:0.889,95%CI:0.837-0.943,P<0.01).Conclusions Sarcopenia and myosteatosis are related to MHE occurrence in hepatitis B-related decompensated cirrhosis and are also the risk factors for OHE occurrence in the medium and long term.Therefore,improving the protein nutrition status of patients may reduce the incidence of MHE and OHE.