多元化运动对老年肝硬化患者肌少症的影响

Effect of diversified exercise on sarcopenia in elderly patients with liver cirrhosis

目的观察多元化运动对老年肝硬化患者肌少症的影响。方法纳入首都医科大学附属北京地坛医院2021年3月~2024年1月住院的96例老年肝硬化患者。患者签订知情同意书入组后采用随机数表法分为多元化运动组和对照组,每组48例。对照组鼓励患者进行适度有氧运动。多元化运动组采用有氧热身—弹力带抗阻—平衡训练方式进行训练。训练频次由每周2次,每次20 min,过渡至每周3次,每次45 min。两组均持续运动16周。训练前后进行握力、步速测试和起立行走计时测试(time up and go test,TUGT)。检测谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)水平及门静脉宽度。结果训练前,两组患者握力、步速、TUGT时长比较,差异无统计学意义(P>0.05)。训练后,多元化运动组握力高于对照组,但组间差异无统计学意义(P>0.05)。多元化运动组步速(0.80±0.19)m/s高于对照组(0.72±0.18)m/s、TUGT时长(16.87±2.93)s低于对照组(18.60±3.34)s,组间差异有统计学意义(t=2.062,2.621,P<0.05)。训练前后两组间ALT、AST、TBIL、门静脉宽度比较,差异无统计学意义(P>0.05)。结论对于肌少症的老年肝硬化患者,开展多元化运动可提高患者的肌肉力量,对下肢肌肉功能改善更为显著,且未增加门静脉高压消化道出血风险。

Objective To observe the effect of diversified exercise on sarcopenia in elderly patients with liver cirrhosis.Methods Ninety-six elderly patients with liver cirrhosis hospitalized between March 2021 and January 2024 were included as the study subjects.After signing the informed consent form,the patients were evenly divided into two groups.The control group was encouraged to engage in moderate aerobic exercise without any requirements for exercise duration or frequency.The diversified exercise group adopted aerobic warm-up,elastic band resistance,and balance training methods for training.The training frequency transitioned from 2 times a week,each lasting 20 minutes,to 3 times a week,each lasting 45 minutes.Both groups continued to exercise for 16 weeks.Before and after training,grip strength,gait speed,and the Timed Up and Go Test(TUGT)were conducted.The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),and portal vein width were measured.Results There was no statistically significant difference in grip strength,walking speed,and TUGT duration between the two groups before training.After training,the grip strength of the diversified exercise group was higher than that of the control group,but there was no statistically significant difference between the groups.The walking speed of the diversified exercise group was(0.80±0.19)m∕s,which was higher than that of the control group's(0.72±0.18)m∕s,and the TUGT duration was(16.87±2.93)s lower than that of the control group's(18.60±3.34)s,with statistically significant differences between the groups(t=2.062,2.621,P<0.05).There was no statistically significant difference in ALT,AST,TBIL,and portal vein width between the two groups before and after training.Conclusion For elderly patients with liver cirrhosis complicated with sarcopenia,conducting diversified exercise can improve muscle strength,significantly improve lower limb muscle function,and does not increase the risk of portal hypertension gastrointestinal bleeding.