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肝硬化肌肉减少症的发病机制及诊治现状

刘嘉 黄华

引用本文:
Citation:

肝硬化肌肉减少症的发病机制及诊治现状

DOI: 10.3969/j.issn.1001-5256.2020.04.041
基金项目: 

云南省应用基础研究(2015FB059); 

详细信息
  • 中图分类号: R575.2

Pathogenesis of sarcopenia in liver cirrhosis and current status of its diagnosis and treatment

Research funding: 

 

  • 摘要: 肌肉减少症是肝硬化营养不良的重要表现形式,已成为肝硬化患者不可忽视的并发症,与患者的生活质量、住院时间、并发症发生率及死亡率密切相关,且对肝移植预后有重要影响,因此,早期诊断及干预治疗对改善肝硬化患者预后极为重要。但目前国内外对于肌肉减少症的诊断标准还未达成共识。近年来随着对肌肉分子调控机制、肌肉生长相关激素、高氨血症介导的信号通路及肠道菌群作用的深入研究,肌肉减少症发生机制被逐渐认识。适当的营养干预、合理运动、降氨治疗、补充激素、分子靶向治疗等可能改善肝硬化患者肌肉质量,将是未来研究的重点。综述了近年来肝硬化肌肉减少症的相关研究,对其流行病学特点、发生机制、诊断及治疗进行简要阐述。

     

  • [1] FIELDING RA,VELLAS B,EVANS WJ,et al. Sarcopenia:An undiagnosed condition in older adults. Current consensus definition:Prevalence,etiology,and consequences. International working group on sarcopenia[J]. J Am Med Dir Assoc,2011,12(4):249-256.
    [2] HANAI T,SHIRAKI M,OHNISHI S,et al. Rapid skeletal muscle wasting predicts worse survival in patients with liver cirrhosis[J]. Hepatol Res,2016,46(8):743-751.
    [3] KIM G,KANG SH,KIM MY,et al. Prognostic value of sarcopenia in patients with liver cirrhosis:A systematic review and meta-analysis[J]. PLo S One,2017,12(10):e0186990.
    [4] PONZIANI FR,GASBARRINI A. Sarcopenia in patients with advanced liver disease[J]. Curr Protein Pept Sci,2018,19(7):681-691.
    [5] SINCLAIR M,GOW PJ,GROSSMANN M,et al. Review article:Sarcopenia in cirrhosis-aetiology,implications and potential therapeutic interventions[J]. Aliment Pharmacol Ther,2016,43(7):765-777.
    [6] LATTANZI B,GIOIA S,di COLA S,et al. Prevalence and impact of sarcopenia in non-cirrhotic portal hypertension[J].Liver Int,2019,39(10):1937-1942.
    [7] CAREY EJ,LAI JC,WANG CW,et al. A multicenter study to define sarcopenia in patients with end-stage liver disease[J]. Liver Transpl,2017,23(5):625-633.
    [8] TANDON P,NEY M,IRWIN I,et al. Severe muscle depletion in patients on the liver transplant wait list:Its prevalence and independent prognostic value[J]. Liver Transpl,2012,18(10):1209-1216.
    [9] HIRAOKA A,MICHITAKA K,UEKI H,et al. Sarcopenia and two types of presarcopenia in Japanese patients with chronic liver disease[J]. Eur J Gastroenterol Hepatol,2016,28(8):940-947.
    [10] NARDELLI S,LATTANZI B,MERLI M,et al. Muscle alterations are associated with minimal and overt hepatic encephalopathy in patients with liver cirrhosis[J]. Hepatology,2019,70(5):1704-1713.
    [11] KANG SH,JEONG WK,BAIK SK,et al. Impact of sarcopenia on prognostic value of cirrhosis:Going beyond the hepatic venous pressure gradient and MELD score[J]. J Cachexia Sarcopenia Muscle,2018,9(5):860-870.
    [12] MONTANO-LOZA AJ,DUARTE-ROJO A,MEZA-JUNCO J,et al. Inclusion of sarcopenia within MELD(MELD-sarcopenia)and the prediction of mortality in patients with cirrhosis[J]. Clin Transl Gastroenterol,2015,6:e102.
    [13] JEONG JY,LIM S,SOHN JH,et al. Presence of sarcopenia and its rate of change are independently associated with long-term mortality in patients with liver cirrhosis[J]. J Korean Med Sci,2018,33(50):e299.
    [14] YU R,SHI Q,LIU L,et al. Relationship of sarcopenia with steatohepatitis and advanced liver fibrosis in non-alcoholic fatty liver disease:A meta-analysis[J]. BMC Gastroenterol,2018,18(1):51.
    [15] MONTANO-LOZA AJ,MEZA-JUNCO J,BARACOS VE,et al. Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation[J]. Liver Transpl,2014,20(6):640-648.
    [16] JOHNSON TM,OVERGARD EB,COHEN AE,et al. Nutrition assessment and management in advanced liver disease[J].Nutr Clin Pract,2013,28(1):15-29.
    [17] MORRISON WL,BOUCHIER IA,GIBSON JN,et al. Skeletal muscle and whole-body protein turnover in cirrhosis[J]. Clin Sci(Lond),1990,78(6):613-619.
    [18] WANG YY,LIN SY,CHUANG YH,et al. Protein nitration is associated with increased proteolysis in skeletal muscle of bile duct ligation-induced cirrhotic rats[J]. Metabolism,2010,59(4):468-472.
    [19] DOMINGUES-FARIA C,CHANET A,SALLES J,et al. Vitamin D deficiency down-regulates Notch pathway contributing to skeletal muscle atrophy in old wistar rats[J]. Nutr Metab(Lond),2014,11(1):47.
    [20] LATRES E,AMINI AR,AMINI AA,et al. Insulin-like growth factor-1(IGF-1)inversely regulates atrophy-induced genes via the phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin(PI3K/Akt/m TOR)pathway[J]. J Biol Chem,2005,280(4):2737-2744.
    [21] KHOSHNOOD A,NASIRI TM,FARAVASH MJ,et al. A survey of correlation between insulin-like growth factor-I(igf-I)levels and severity of liver cirrhosis[J]. Hepat Mon,2013,13(2):e6181.
    [22] LIU W,THOMAS SG,ASA SL,et al. Myostatin is a skeletal muscle target of growth hormone anabolic action[J]. J Clin Endocrinol Metab,2003,88(11):5490-5496.
    [23] QIU J,THAPALIYA S,RUNKANA A,et al. Hyperammonemia in cirrhosis induces transcriptional regulation of myostatin by an NF-kappaB-mediated mechanism[J]. Proc Natl Acad Sci USA,2013,110(45):18162-18167.
    [24] MORINE KJ,BISH LT,PENDRAK K,et al. Systemic myostatin inhibition via liver-targeted gene transfer in normal and dystrophic mice[J]. PLo S One,2010,5(2):e9176.
    [25] CHEN Y,ZAJAC JD,MACLEAN HE. Androgen regulation of satellite cell function[J]. J Endocrinol,2005,186(1):21-31.
    [26] ESTRADA M,ESPINOSA A,MLLER M,et al. Testosterone stimulates intracellular calcium release and mitogen-activated protein kinases via a G protein-coupled receptor in skeletal muscle cells[J]. Endocrinology,2003,144(8):3586-3597.
    [27] IBEBUNJO C,EASH JK,LI C,et al. Voluntary running,skeletal muscle gene expression,and signaling inversely regulated by orchidectomy and testosterone replacement[J]. Am J Physiol Endocrinol Metab,2011,300(2):e327-e340.
    [28] SINCLAIR M,GROSSMANN M,HOERMANN R,et al. Testosterone therapy increases muscle mass in men with cirrhosis and low testosterone:A randomised controlled trial[J]. J Hepatol,2016,65(5):906-913.
    [29] TSIEN C,DAVULURI G,SINGH D,et al. Metabolic and molecular responses to leucine-enriched branched chain amino acid supplementation in the skeletal muscle of alcoholic cirrhosis[J]. Hepatology,2015,61(6):2018-2029.
    [30] LIN R,LIU W,PIAO M,et al. A review of the relationship between the gut microbiota and amino acid metabolism[J]. Amino Acids,2017,49(12):2083-2090.
    [31] MANGNER N,LINKE A,OBERBACH A,et al. Exercise training prevents TNF-alpha induced loss of force in the diaphragm of mice[J]. PLo S One,2013,8(1):e52274.
    [32] KO F,ABADIR P,MARX R,et al. Impaired mitochondrial degradation by autophagy in the skeletal muscle of the aged female interleukin 10 null mouse[J]. Exp Gerontol,2016,73:23-27.
    [33] TICINESI A,LAURETANI F,TANA C,et al. Exercise and immune system as modulators of intestinal microbiome:Implications for the gut-muscle axis hypothesis[J]. Exerc Immunol Rev,2019,25:84-95.
    [34] YAN J,HERZOG JW,TSANG K,et al. Gut microbiota induce IGF-1 and promote bone formation and growth[J]. Proc Natl Acad Sci U S A,2016,113(47):e7554-e7563.
    [35] BEYER I,METS T,BAUTMANS I. Chronic low-grade inflammation and age-related sarcopenia[J]. Curr Opin Clin Nutr Metab Care,2012,15(1):12-22.
    [36] BONET-PONCE L,SAEZ-ATIENZAR S,DA CASA C,et al.On the mechanism underlying ethanol-induced mitochondrial dynamic disruption and autophagy response[J]. Biochim Biophys Acta,2015,1852(7):1400-1409.
    [37] CRUZ-JENTOFT AJ,BAEYENS JP,BAUER JM,et al. Sarcopenia:European consensus on definition and diagnosis:Report of the European Working Group on Sarcopenia in older people[J]. Age Ageing,2010,39(4):412-423.
    [38] Chinese Society of Hepatology,Chinese Society of Gastroenterology,Chinese Medical Association. Clinical guidelines on nutrition in end-stage liver disease[J]. J Clin Hepatol,2019,35(6):1222-1230.(in Chinese)中华医学会肝病学分会,中华医学会消化病学分会.终末期肝病临床营养指南[J].临床肝胆病杂志,2019,35(6):1222-1230.
    [39] CHEN LK,LIU LK,WOO J,et al. Sarcopenia in Asia:Consensus report of the Asian Working Group for Sarcopenia[J].J Am Med Dir Assoc,2014,15(2):95-101.
    [40] TSIEN C,GARBER A,NARAYANAN A,et al. Post-liver transplantation sarcopenia in cirrhosis:A prospective evaluation[J]. J Gastroenterol Hepatol,2014,29(6):1250-1257.
    [41] KITAJIMA Y,TAKAHASHI H,AKIYAMA T,et al. Supplementation with branched-chain amino acids ameliorates hypoalbuminemia,prevents sarcopenia,and reduces fat accumulation in the skeletal muscles of patients with liver cirrhosis[J]. J Gastroenterol,2018,53(3):427-437.
    [42] European Association for the Study of the Liver. EASL clinical practice guidelines on nutrition in chronic liver disease[J]. J Hepatol,2019,70(1):172-193.
    [43] TSIEN CD,MCCULLOUGH AJ,DASARATHY S. Late evening snack:Exploiting a period of anabolic opportunity in cirrhosis[J]. J Gastroenterol Hepatol,2012,27(3):430-441.
    [44] OHARA M,OGAWA K,SUDA G,et al. L-Carnitine suppresses loss of skeletal muscle mass in patients with liver cirrhosis[J]. Hepatol Commun,2018,2(8):906-918.
    [45] LOCKLEAR CT,GOLABI P,GERBER L,et al. Exercise as an intervention for patients with end-stage liver disease:Systematic review[J]. Medicine(Baltimore), 2018, 97(42):e12774.
    [46] ASCENZI F,BARBERI L,DOBROWOLNY G,et al. Effects of IGF-1 isoforms on muscle growth and sarcopenia[J]. Aging Cell,2019,18(3):e12954.
    [47] KUMAR A,DAVULURI G,SILVA R,et al. Ammonia lowering reverses sarcopenia of cirrhosis by restoring skeletal muscle proteostasis[J]. Hepatology,2017,65(6):2045-2058.
    [48] HAN HQ,ZHOU X,MITCH WE,et al. Myostatin/activin pathway antagonism:Molecular basis and therapeutic potential[J]. Int J Biochem Cell Biol,2013,45(10):2333-2347.
    [49] BERGERSON JT,LEE JG,FURLAN A,et al. Liver transplantation arrests and reverses muscle wasting[J]. Clin Transplant,2015,29(3):216-221.
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  • 出版日期:  2020-04-20
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