肝硬化合并肌少症的影响因素分析

Influencing factors of liver cirrhosis complicated with sarcopenia

目的分析肝硬化合并肌少症病人的影响因素。方法收集2021年6月至2022年5月新疆医科大学第四附属医院住院的肝硬化病人共215例,采集人口学信息、血清学指标、病因、肝硬化相关并发症、肝功能评分(CTP)、终末期肝病模型(MELD)等临床资料;同时,进行营养风险筛查及营养评估[包括优势手握力、步速、三头肌皮褶厚度(TSF)、上臂围、上臂肌围(AMC)、小腿围]。应用依莱达临床影像分析系统(RADinfo systems)分析采集第3腰椎(L3)平面CT影像信息,并计算L3骨骼肌质量指数(SMI),以L3-SMI<50 cm^(2)/m^(2)(男性)或<39 cm^(2)/m^(2)(女性)为诊断标准评估肌少症,将病人分为肌少症组和无肌少症组,进一步采用多因素logistic回归分析法筛选肌少症发生的影响因素。结果住院肝硬化合并肌少症病人的发生率为68.3%;两组病人在年龄、腹水、食管静脉曲张出血、MELD低危(≤14分)、MELD高危(>18分)、红细胞计数(RBC)、血红蛋白(HGB)、营养评分、营养风险、BMI、优势手握力、上臂围、小腿围、三头肌皮褶厚度(TSF)、上臂肌围(AMC)比较均差异有统计学意义(P<0.05);非肌少症证组病人优势手握力32.25(19.70,45.62)kg明显高于肌少症组病人13.50(5.33,40.83)kg;多因素logistic回归分析结果示:营养评分[OR=1.78,95%CI:(1.28,2.48),P=0.001]和BMI[OR=0.69,95%CI:(0.61,0.77),P<0.001]是肝硬化合并肌少症病人的影响因素。结论营养评分和低BMI是住院肝硬化合并肌少症病人的影响因素。

Objective To analyze the influencing factors of patients with liver cirrhosis and sarcopenia.Methods A total of 215 in-patients with liver cirrhosis in the Fourth Affiliated Hospital of Xinjiang Medical University from 2021 June to May 2022 were selected.Demographic information,serological parameters,etiology,cirrhosis-related complications,CTP score,MELD and other clinical data were collected.At the same time,nutritional risk screening and nutritional assessment including dominant handgrip strength,gait speed,triceps skinfold thickness(TSF),upper arm circumference,upper arm muscle circumference(AMC)and calf circumference were performed.The CT images of L3 were collected and analyzed by Elida clinical imaging analysis system(RADinfo SYSTEMS),and the skeletal muscle mass index(SMI)was calculated.The diagnostic criteria of sarcopenia was L3-SMI<50 cm^(2)/m^(2)(male)or<39 cm^(2)/m^(2)(fe-male).The patients were assigned into sarcopenia group and non-sarcopenia group,and multivariate logistic regression analysis was used to screen the influencing factors of Sarcopenia.Results The incidence of myasthenia gravis in hospitalized patients with cirrhosis was 68.3%.There were significant differences in age,ascites,esophageal varicose veins bleeding,low MELD risk(≤14 points),high MELD risk(>18 points),RBC and HGB of the serological indexes,nutritional score,nutritional risk,BMI,dominant hand grip strength,arm circumference,leg circumference,TSF and AMC in nutrition risk assessment between the two groups(P<0.05).The dominant hand grip strength of the patients with non-sarcopenia syndrome was 32.25(19.70,45.62),which was significantly higher than that of the patients with sarcopenia syndrome 13.50(5.33,40.83).Multivariate Logistic regression analysis showed that nutritional score≥3points[OR=1.78,95%CI(1.28,2.48),P=0.001]and BMI[OR=0.69,95%CI(0.61,0.77),P<0.001]were the influencing factors in liv-er cirrhosis patients combined with sarcopenia.Conclusion Nutritional score and low BMI are the influencing factors in hospitalized patients with liver cirrhosis combined with sarcopenia.