肌少症与新型慢加急性肝衰竭5种临床分型的关系

The relationship between sarcopenia and five new clinical types of acute liver failure

目的探究肌少症与新型慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)5种临床分型的关系。方法收集2019年1月至2022年1月在首都医科大学附属北京佑安医院住院的391例ACLF患者信息以及入院时营养相关指标,按照新型临床分型将患者分为快速进展型(A型,119例)、快速恢复型(B型,156例)、缓慢进展型(C型,51例)、缓慢恢复型(D型,38例)、缓慢持续型(E型,27例),借助CT成像测量营养指标,比较不同分型患者肌少症等营养指标的检出率,探究肌少症与新型ACLF 5种临床分型的关系。结果A型(35例,29%)和C型(18例,35%)肌少症检出率高于B型(20例,13%)、D型(3例,8%)和E型(27例,7%),差异具有统计学意义(P<0.05)。A型(36例,30.3%)肌脂肪变性患者检出率高于B型(29例,18.6%),C型(11例,21.6%)肌脂肪变性患者检出率高于D型(5例,13.2%),差异均有统计学意义(P=0.018)。A型(16例,13.4%)和C型(7例,13.7%)肌少性肥胖检出率高于B型(11例,7.0%)和D型(1例,2.6%),差异均有统计学意义(P=0.047)。结论肌少症等营养指标与新型慢加急性肝衰竭5种临床分型密切相关。基线肌肉减少的ACLF患者中短期(4~12周)预后差,4周内快速进展(A型)或12周时仍缓慢进展(C型)的概率高。因此,应在ACLF诊断同时尽早评估肌少症等营养指标,以期通过有效的营养干预提高ACLF患者的整体治疗效果,改善预后,提高患者生存质量。

Objective To explore the relationship between sarcopenia and five clinical types of acute-on-chronic liver failure(ACLF).Methods From January 2019 to January 2022,a total of 391 patients with ACLF in Beijing You’an Hospital affiliated to Capital Medical University were collected,and the patients were divided into rapid progression(type A,119 cases),rapid recovery(type B,156 cases),slow progression(type C,51 cases),slow recovery(type D,38 cases)and slow persistency(type E,27cases),ac-cording to the new clinical type.With the help of CT imaging,nutritional indicators were measured,the incidence of nutritional indica-tors such as sarcopenia in patients with different types were compared,and the relationship between sarcopenia and five clinical types of new ACLF was explored.Results The incidences of sarcopenia in type A(35 cases,29%)and type C(18 cases,35%)were higher than that in type B(20 cases,13%),type D(3 cases,8%)and type E(27 cases,7%),and the differences were statistically significant(P<0.05).The detection rate of myosteatosis patients in type A(36 cases,30.3%)was higher than that in type B(29 cases,18.6%),and the detection rate of myosteatosis patients in type C(11 cases,21.6%)was higher than that in type D(5 cases,13.2%),with statis-tical significance(P=0.018).The detection rate of sarcopenic obesity in type A(16 cases,13.4%)and type C(7 cases,13.7%)were higher than that in type B(11 cases,7.0%)and type D(1 case,2.6%),and the differences were statistically significant(P=0.047).Conclusion Nutritional indexes such as sarcopenia were closely related to five clinical types of new acute liver failure.ACLF patients with baseline sarcopenia had poor short-term prognosis(4~12 weeks),and the probability of rapid progress within 4 weeks(type A)or slow progress at 12 weeks(type D)was high.Therefore,nutritional indexes such as sarcopenia should be evaluated as soon as ACLF is diagnosed,so as to improve the overall therapeutic effect,prognosis and quality of life through effective nutritional intervention.