中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肝硬化肌少症的发病机制与诊疗现状

刘钰懿 陈东风 颜綦先

引用本文:
Citation:

肝硬化肌少症的发病机制与诊疗现状

DOI: 10.3969/j.issn.1001-5256.2022.01.033
基金项目: 

国家自然科学基金 (81972305)

利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:刘钰懿、陈东风负责调研整理文献,设计论文框架,撰写论文; 颜綦先负责终审论文。
详细信息
    通信作者:

    颜綦先,402010444@qq.com

Current status of the pathogenesis, diagnosis, and treatment of sarcopenia in patients with liver cirrhosis

Research funding: 

National Natural Science Foundation of China (81972305)

  • 摘要: 肌少症是肝硬化患者常见的并发症,发病率高达40%~70%,增加肝硬化患者并发症的发生,严重影响患者的生活质量和生存期。肝硬化肌少症发病机制复杂,临床表现易被忽略,诊断标准尚未达成共识,针对性治疗药物较少,亟待临床医生高度重视,并加强其发病机制的研究和治疗药物的研发。

     

  • [1] 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. DOI: 10.1002/lt.23495.
    [2] ROSENBERG IH. Sarcopenia: Origins and clinical relevance[J]. Clin Geriatr Med, 2011, 27(3): 337-339. DOI: 10.1016/j.cger.2011.03.003.
    [3] 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. DOI: 10.1093/ageing/afq034.
    [4] PENG S, PLANK LD, MCCALL JL, et al. Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: A comprehensive study[J]. Am J Clin Nutr, 2007, 85(5): 1257-1266. DOI: 10.1093/ajcn/85.5.1257.
    [5] HAO RR, WANG H, WANG HY, et al. Analysis of risk factors for senile sarcopenia and its relationship with NAFLD[J]. J Clin Exp Med, 2020, 319(15): 1588-1591. DOI: 10.3969/j.issn.1671-4695.2020.15.006.

    郝瑞瑞, 王欢, 王海燕, 等. 老年肌少症的危险因素分析及与NAFLD的关系研究[J]. 临床和实验医学杂志, 2020, 319(15): 1588-1591. DOI: 10.3969/j.issn.1671-4695.2020.15.006.
    [6] KIM G, KANG SH, KIM MY, et al. Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis[J]. PLoS One, 2017, 12(10): e0186990. DOI: 10.1371/journal.pone.0186990.
    [7] NISHIKAWA H, ENOMOTO H, ISHⅡ A, et al. Elevated serum myostatin level is associated with worse survival in patients with liver cirrhosis[J]. J Cachexia Sarcopenia Muscle, 2017, 8(6): 915-925. DOI: 10.1002/jcsm.12212.
    [8] LEE JH, JUN HS. Role of myokines in regulating skeletal muscle mass and function[J]. Front Physiol, 2019, 10: 42. DOI: 10.3389/fphys.2019.00042.
    [9] WING SS, LECKER SH, JAGOE RT. Proteolysis in illness-associated skeletal muscle atrophy: From pathways to networks[J]. Crit Rev Clin Lab Sci, 2011, 48(2): 49-70. DOI: 10.3109/10408363.2011.586171.
    [10] YANG QQ, SUN Y. Research progress on molecular mechanism of skeletal muscle mass reduction in sarcopenia[J]. J Clin Exp Med, 2020, 313(9): 1006-1009. DOI: 10.3969/j.issn.1671-4695.2020.09.032.

    杨琦琦, 孙颖. 肌少症中骨骼肌质量减少的分子机制研究进展[J]. 临床和实验医学杂志, 2020, 313(9): 1006-1009. DOI: 10.3969/j.issn.1671-4695.2020.09.032.
    [11] EGERMAN MA, GLASS DJ. Signaling pathways controlling skeletal muscle mass[J]. Crit Rev Biochem Mol Biol, 2014, 49(1): 59-68. DOI: 10.3109/10409238.2013.857291.
    [12] HAN HQ, MITCH WE. Targeting the myostatin signaling pathway to treat muscle wasting diseases[J]. Curr Opin Support Palliat Care, 2011, 5(4): 334-341. DOI: 10.1097/SPC.0b013e32834bddf9.
    [13] SCHIAFFINO S, DYAR KA, CICILIOT S, et al. Mechanisms regulating skeletal muscle growth and atrophy[J]. FEBS J, 2013, 280(17): 4294-4314. DOI: 10.1111/febs.12253.
    [14] WANG Y, PESSIN JE. Mechanisms for fiber-type specificity of skeletal muscle atrophy[J]. Curr Opin Clin Nutr Metab Care, 2013, 16(3): 243-250. DOI: 10.1097/MCO.0b013e328360272d.
    [15] LEE K, OCHI E, SONG H, et al. Activation of AMP-activated protein kinase induce expression of FoxO1, FoxO3a, and myostatin after exercise-induced muscle damage[J]. Biochem Biophys Res Commun, 2015, 466(3): 289-294. DOI: 10.1016/j.bbrc.2015.08.126.
    [16] GLASS C, HIPSKIND P, TSIEN C, et al. Sarcopenia and a physiologically low respiratory quotient in patients with cirrhosis: A prospective controlled study[J]. J Appl Physiol (1985), 2013, 114(5): 559-565. DOI: 10.1152/japplphysiol.01042.2012.
    [17] BHANJI RA, MOCTEZUMA-VELAZQUEZ C, DUARTE-ROJO A, et al. Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis[J]. Hepatol Int, 2018, 12(4): 377-386. DOI: 10.1007/s12072-018-9875-9.
    [18] DASARATHY S, HATZOGLOU M. Hyperammonemia and proteostasis in cirrhosis[J]. Curr Opin Clin Nutr Metab Care, 2018, 21(1): 30-36. DOI: 10.1097/MCO.0000000000000426.
    [19] DAVULURI G, ALLAWY A, THAPALIYA S, et al. Hyperammonaemia-induced skeletal muscle mitochondrial dysfunction results in cataplerosis and oxidative stress[J]. J Physiol, 2016, 594(24): 7341-7360. DOI: 10.1113/JP272796.
    [20] DAM G, OTT P, AAGAARD NK, et al. Branched-chain amino acids and muscle ammonia detoxification in cirrhosis[J]. Metab Brain Dis, 2013, 28(2): 217-220. DOI: 10.1007/s11011-013-9377-3.
    [21] QIU J, THAPALIYA S, RUNKANA A, et al. Hyperammonemia in cirrhosis induces transcriptional regulation of myostatin by an NF-κB-mediated mechanism[J]. Proc Natl Acad Sci U S A, 2013, 110(45): 18162-18167. DOI: 10.1073/pnas.1317049110.
    [22] ÁBRIGO J, ELORZA AA, RIEDEL CA, et al. Role of oxidative stress as key regulator of muscle wasting during cachexia[J]. Oxid Med Cell Longev, 2018, 2018: 2063179. DOI: 10.1155/2018/2063179.
    [23] DAVULURI G, KROKOWSKI D, GUAN BJ, et al. Metabolic adaptation of skeletal muscle to hyperammonemia drives the beneficial effects of l-leucine in cirrhosis[J]. J Hepatol, 2016, 65(5): 929-937. DOI: 10.1016/j.jhep.2016.06.004.
    [24] NARDELLI S, LATTANZI B, TORRISI S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement[J]. Clin Gastroenterol Hepatol, 2017, 15(6): 934-936. DOI: 10.1016/j.cgh.2016.10.028.
    [25] DASARATHY J, ALKHOURI N, DASARATHY S. Changes in body composition after transjugular intrahepatic portosystemic stent in cirrhosis: A critical review of literature[J]. Liver Int, 2011, 31(9): 1250-1258. DOI: 10.1111/j.1478-3231.2011.02498.x.
    [26] PONZIANI FR, GASBARRINI A. Sarcopenia in patients with advanced liver disease[J]. Curr Protein Pept Sci, 2018, 19(7): 681-691. DOI: 10.2174/1389203718666170428121647.
    [27] 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(7): e102. DOI: 10.1038/ctg.2015.31.
    [28] HAN E, LEE YH, KIM BK, et al. Sarcopenia is associated with the risk of significant liver fibrosis in metabolically unhealthy subjects with chronic hepatitis B[J]. Aliment Pharmacol Ther, 2018, 48(3): 300-312. DOI: 10.1111/apt.14843.
    [29] 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. DOI: 10.1002/lt.24750.
    [30] WELLS CI, MCCALL JL, PLANK LD. Relationship between total body protein and cross-sectional skeletal muscle area in liver cirrhosis is influenced by overhydration[J]. Liver Transpl, 2019, 25(1): 45-55. DOI: 10.1002/lt.25314.
    [31] DICHI JB, DICHI I, MAIO R, et al. Whole-body protein turnover in malnourished patients with child class B and C cirrhosis on diets low to high in protein energy[J]. Nutrition, 2001, 17(3): 239-242. DOI: 10.1016/s0899-9007(00)00567-0.
    [32] CHEN XM, WANG Q, CHENG DL, et al. Correlation analysis of sarcopenia and hepatic encephalopathy in patients with hepatitis B cirrhosis[J]. Chin J Clin Nutr, 2021, 28(5): 290-296. DOI: 10.3760/cma.j.cn115822-20200902-00204.

    陈晓明, 王乔, 成德雷, 等. 乙型肝炎病毒感染后肝硬化患者肌肉减少与肝性脑病的相关性分析[J]. 中华临床营养杂志, 2021, 28(5): 290-296. DOI: 10.3760/cma.j.cn115822-20200902-00204.
    [33] 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. DOI: 10.1016/j.jhep.2018.06.024.
    [34] AMODIO P, BEMEUR C, BUTTERWORTH R, et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus[J]. Hepatology, 2013, 58(1): 325-336. DOI: 10.1002/hep.26370.
    [35] 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. DOI: 10.1007/s00535-017-1370-x.
    [36] PLAUTH M, CABRé E, CAMPILLO B, et al. ESPEN guidelines on parenteral nutrition: Hepatology[J]. Clin Nutr, 2009, 28(4): 436-444. DOI: 10.1016/j.clnu.2009.04.019.
    [37] 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. DOI: 10.1002/hep.27717.
    [38] MALAGUARNERA M, VACANTE M, GIORDANO M, et al. Oral acetyl-L-carnitine therapy reduces fatigue in overt hepatic encephalopathy: A randomized, double-blind, placebo-controlled study[J]. Am J Clin Nutr, 2011, 93(4): 799-808. DOI: 10.3945/ajcn.110.007393.
    [39] EBADI M, BHANJI RA, MAZURAK VC, et al. Severe vitamin D deficiency is a prognostic biomarker in autoimmune hepatitis[J]. Aliment Pharmacol Ther, 2019, 49(2): 173-182. DOI: 10.1111/apt.15029.
    [40] KONSTANTAKIS C, TSELEKOUNI P, KALAFATELI M, et al. Vitamin D deficiency in patients with liver cirrhosis[J]. Ann Gastroenterol, 2016, 29(3): 297-306. DOI: 10.20524/aog.2016.0037.
    [41] BECKER C, LORD SR, STUDENSKI SA, et al. Myostatin antibody (LY2495655) in older weak fallers: A proof-of-concept, randomised, phase 2 trial[J]. Lancet Diabetes Endocrinol, 2015, 3(12): 948-957. DOI: 10.1016/S2213-8587(15)00298-3.
    [42] PICARDI A, de OLIVEIRA AC, MUGUERZA B, et al. Low doses of insulin-like growth factor-I improve nitrogen retention and food efficiency in rats with early cirrhosis[J]. J Hepatol, 1997, 26(1): 191-202. DOI: 10.1016/s0168-8278(97)80026-8.
    [43] YURCI A, YUCESOY M, UNLUHIZARCI K, et al. Effects of testosterone gel treatment in hypogonadal men with liver cirrhosis[J]. Clin Res Hepatol Gastroenterol, 2011, 35(12): 845-854. DOI: 10.1016/j.clinre.2011.09.005.
    [44] DUARTE-ROJO A, RUIZ-MARGÁIN A, MONTAÑO-LOZA AJ, et al. Exercise and physical activity for patients with end-stage liver disease: Improving functional status and sarcopenia while on the transplant waiting list[J]. Liver Transpl, 2018, 24(1): 122-139. DOI: 10.1002/lt.24958.
    [45] TANDON P, ISMOND KP, RIESS K, et al. Exercise in cirrhosis: Translating evidence and experience to practice[J]. J Hepatol, 2018, 69(5): 1164-1177. DOI: 10.1016/j.jhep.2018.06.017.
  • 加载中
计量
  • 文章访问数:  559
  • HTML全文浏览量:  126
  • PDF下载量:  115
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-06-10
  • 录用日期:  2021-07-30
  • 出版日期:  2022-01-20
  • 分享
  • 用微信扫码二维码

    分享至好友和朋友圈

目录

    /

    返回文章
    返回