基于定量CT分析肝硬化患者肌少症、腰椎骨密度和肝脏脂肪含量的相关性

Correlation analysis of sarcopenia,lumbar bone mineral density and liver fat content in patients with liver cirrhosis based on quantitative CT

目的:基于定量CT(QCT)探讨肝硬化患者中肌少症、腰椎骨密度(BMD)和肝脏脂肪含量的相关性。方法:将2019年7月-2021年12月在本院诊断为肝硬化的163例患者(肝硬化组)及年龄、性别相匹配的100例健康体检者(对照组)纳入本研究。所有被试者行腹部CT平扫。采用QCT Pro软件测量在每例受试者L3椎体水平骨骼肌面积(SMA-L3)、腰椎BMD、肝脏脂肪分数(Fat%-QCT)。根据Child-Pugh评分,将肝硬化患者分为Child-Pugh A级、B级和C级三组。L3椎体水平骨骼肌指数(SMI-L3)为SMA-L3/身高^(2)。根据男性患者SMI-L3<50cm^(2)/m^(2),女性患者SMI-L3<39cm^(2)/m^(2)将肝硬化患者分为肌少症组和非肌少症组。结果:肝硬化组SMI-L3及腰椎BMD均低于对照组(P<0.05),Fat%-QCT高于对照组(P<0.001)。Child-Pugh A、B、C级肝硬化患者肌少症发生率逐渐增加(P<0.05),C级患者的Fat%-QCT高于A级和B级(P<0.001)。肝硬化患者肌少症组的年龄高于非肌少症组,腰椎BMD低于非肌少症组(P<0.001)。多元逻辑回归分析显示,女性、年龄及合并肌少症是肝硬化患者骨质疏松的独立危险因素(P<0.05)。结论:随着肝功能的下降,肝硬化患者肌少症发生率和肝脏脂肪含量逐渐增高;肝硬化伴肌少症患者更易发生骨质疏松。

Objective:To explore the correlation between sarcopenia,lumbar bone mineral density(BMD)and liver fat content in patients with liver cirrhosis based on quantitative CT(QCT).Methods:163 patients with liver cirrhosis(liver cirrhosis group)and 100 healthy people(control group)age-and gender-matched in our Hospital from July 2019 to December 2021 were included in this study.All subjects underwent abdominal CT scan.The skeletal muscle area(SMA-L3),lumbar BMD and liver fat fraction(fat%-QCT)at the third lumbar vertebral plane were measured using QCT Pro software.According to the child Pugh score,the patients were divided into three groups of child Pugh class A,class B and class C.The L3 vertebral level skeletal muscle index(SMI-L3)was SMI-L3/height^(2).Patients with liver cirrhosis were classified into the sarcopenic and non-sarcopenic groups by the male patient SMI-L3<50cm^(2)/m^(2) and the female patient SMI-L3<39cm^(2)/m^(2).Results:SMI-L3 and lumbar BMD in liver cirrhosis group were lower than those in control group(both P<0.05),and fat%-QCT in liver cirrhosis group was higher than that in control group(P<0.001).The incidence of sarcopenia increased gradually from child Pugh class A,B to C in cirrhotic patients(P<0.05),and the fat%-QCT of class C group was higher than that of class A and B groups(P<0.001).The sarcopenia group was older than that in the non-sarcopenia group,and the lumbar BMD was lower than that in the non-sarcopenia group(both P<0.001).Multiple ordered logistic regression analysis showed that female,age and sarcopenia were independent risk factors for osteoporosis in patients with liver cirrhosis(all P<0.05).Conclusion:With the decline of liver function,the incidence of sarcopenia and liver fat content in patients with liver cirrhosis increases gradually;those complicated with sarcopenia are more likely to develop osteoporosis.