肝移植围术期肌少症的研究进展

Research progress on perioperative sarcopenia in liver transplantation

失代偿性肝硬化、重型肝炎等终末期肝病的最终治疗手段是肝移植,该过程中肌少症发病率高达43.4%。肌少症会明显增加术后并发症、延长住院时间、缩短术后生存时间,严重影响患者预后。目前主要通过术前腹部计算机断层扫描图像计算第三腰椎平面骨骼肌含量来评估肌少症。现有研究证明,肝移植患者存在营养物质摄入不足和代谢紊乱导致的蛋白质合成率降低,已发现的肝-肌轴介质(如高氨血症、低生长激素和睾酮、内毒素血症等)、潜在的介质(如成纤维细胞生长因子21)、肠道菌群在肝移植相关肌少症中发挥重要作用。文中回顾了肝移植围术期肌少症研究的最新进展,结合临床实践认为,采取合理的营养素和激素补充、个性化的阻抗锻炼、阻断肝-肌轴介质通路等联合治疗手段,提高临床医生对肌少症的重视程度,可能改善甚至逆转肌少症,有效减少患者围术期并发症,提高患者术后长期预后。

Liver transplantation is the ultimate treatment for end-stage liver diseases such as decompensated cirrhosis and severe hepatitis,but with the sarcopenia incidence of up to 43.4%.Sarcopenia can significantly increase postoperative complications,prolong hospital stay,shorten postoperative survival and seriously affect patient prognosis.At present,sarcopenia is mainly evaluated by calculating the skeletal muscle measurement at the level of third lumbar vertebra on preoperative abdominal computed tomography images.Existing studies have demonstrated that the protein synthesis rate is reduced due to insufficient nutrient intake and metabolic disorder in liver transplantation patients.The identified liver-muscle axis mediators(e.g.,hyperammonemia,low growth hormone and testosterone,endotoxemia),potential mediators(e.g.,fibroblast growth factor 21)and gut microbiota play an important role in liver transplantation related sarcopenia.This paper reviewed the latest progress on the studies of perioperative sarcopenia in liver transplantation.Combining clinical practice,it is believed that combined therapy of rational nutrition and hormone supplementation,individualized resistance training and liver-muscle axis mediator pathway blockade,together with enhancement of clinicians'recognition of sarcopenia,may ameliorate or even reverse sarcopenia,effectively reduce perioperative complications and improve long-term prognosis of patients.