运动疗法对肝硬化伴肌少症的作用及其机制

廖粤生; 白莉莉

doi:10.3969/j.issn.1001-5256.2022.03.036

运动疗法对肝硬化伴肌少症的作用及其机制

DOI: 10.3969/j.issn.1001-5256.2022.03.036

廖粤生,
白莉莉^, ,

天津师范大学体育科学学院，天津 300387

基金项目:

国家社会科学基金重大项目 (19ZDA353);

国家社会科学基金青年项目 (20CTY004)

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：廖粤生负责拟定写作思路，分析资料，撰写及修改论文；白莉莉负责指导撰写文章并最后定稿。

详细信息

通信作者:
白莉莉，blx0305@163.com

计量
- 文章访问数: 530
- HTML全文浏览量: 230
- PDF下载量: 44
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-27
- 录用日期: 2021-09-16
- 出版日期: 2022-03-20

Role and mechanism of exercise in improving liver cirrhosis with sarcopenia

Yuesheng LIAO,
Lili BAI^{,
,}

School of Physical Sciences, Tianjin Normal University, Tianjin 300387, China

Research funding:

The National Social Science Fund of China (19ZDA353);

The National Social Science Fund of China (20CTY004)

More Information

Corresponding author: BAI Lili, blx0305@163.com(ORCID: 0000-0002-2216-8723)

摘要

摘要: 肌少症是肝硬化患者营养不良的重要表现，是肝硬化常见的并发症之一，30%~70%的肝硬化患者并发肌少症，严重影响生存和预后。运动疗法对于治疗此类疾病具有副作用少、效益高、操作性强等诸多优势。本文通过梳理国内外关于运动与肝硬化伴肌少症的相关理论研究和应用成果，循证运动对肝硬化伴肌少症的影响及相关机制，以期为治疗肝硬化伴肌少症提供科学的理论参考。
- 肝硬化 /
- 肌减少症 /
- 运动疗法
Abstract: Sarcopenia is an important manifestation of malnutrition in patients with liver cirrhosis and is one of the common complications of liver cirrhosis, and about 30%-70% of the patients with liver cirrhosis suffer from sarcopenia, which seriously affects the survival and prognosis of patients. Studies have shown that exercise therapy has many advantages in the treatment of such diseases, such as few side effects, high benefits, and simple operability. To summarize the theoretical studies and application results of exercise in liver cirrhosis with sarcopenia and find evidence for the effect of exercise on liver cirrhosis with sarcopenia and related mechanisms, in order to provide a scientific reference for the treatment of liver cirrhosis with sarcopenia.
- Liver Cirrhosis /
- Sarcopenia /
- Exercise Therapy

HTML全文

图 1 运动改善肝硬化伴肌少症的可能机制

下载: 全尺寸图片幻灯片

表 1 有氧运动与抗阻运动对肝硬化伴肌少症患者的影响

研究对象	例数	运动类型	运动时间	研究结果	文献
肝硬化患者	92	有氧运动	2~3个月，2次/周	VO_{2 max}↑ 体能↑ 肌肉质量↑	[23]
肝硬化患者	9	有氧运动	8周，3次/周	VO_{2 max}↑ 肌肉质量↑ 疲劳↓	[24]
肝硬化患者	30	有氧运动	6周，3次/周，45 min/次	VO_{2 max}↑ 肌肉质量↑	[25]
肝硬化患者	19	有氧运动	3个月，3次/周，30 min/次	上臂围↑ 肌肉质量↑	[26]
肝硬化患者	39	抗阻运动	12周，3次/周	肌肉力量↑ 生活质量评分↑	[27]
肝硬化患者	13	抗阻运动	12周，2次/周，20 min/次	VO_{2 max}↑ 肌肉力量↑ 肌肉质量↑	[28]
肝硬化患者	-	抗阻运动	2~3次/周，45~60 min/次	肌肉力量↑ 肌肉质量↑	[29]
注：“-”表示文献中无相关数据；VO_{2 max}表示最大摄氧量；“↑”表示上升；“↓”表示下降。

下载: 导出CSV

参考文献(47)

[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. DOI: 10.1016/j.jamda.2011.01.003.
[2]	VURAL A, ATTAWAY A, WELCH N, et al. Skeletal muscle loss phenotype in cirrhosis: A nationwide analysis of hospitalized patients[J]. Clin Nutr, 2020, 39(12): 3711-3720. DOI: 10.1016/j.clnu.2020.03.032.
[3]	YANG QQ, SUN Y. Research progress on molecular mechanism of skeletal muscle mass reduction in sarcopenia[J]. J Clin Exp Med, 2020, 19(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, 19(9): 1006-1009. DOI: 10.3969/j.issn.1671-4695.2020.09.032.
[4]	WILLIAMS FR, BERZIGOTTI A, LORD JM, et al. Review article: Impact of exercise on physical frailty in patients with chronic liver disease[J]. Aliment Pharmacol Ther, 2019, 50(9): 988-1000. DOI: 10.1111/apt.15491.
[5]	ROSENBERG IH. Sarcopenia: Origins and clinical relevance[J]. Clin Geriatr Med, 2011, 27(3): 337-339. DOI: 10.1016/j.cger.2011.03.003.
[6]	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.
[7]	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. DOI: 10.1016/j.jamda.2011.01.003.
[8]	MONTANO-LOZA AJ, MEZA-JUNCO J, PRADO CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis[J]. Clin Gastroenterol Hepatol, 2012, 10(2): 166-173, 173.e1. DOI: 10.1016/j.cgh.2011.08.028.
[9]	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.
[10]	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.
[11]	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. DOI: 10.1111/liv.14160.
[12]	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.
[13]	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.
[14]	LIU J, HUANG H. Pathogenesis and current status of diagnosis and treatment of cirrhotic sarcopenia[J]. J Clin Hepatol, 2020, 36(4): 895-899. DOI: 10.3969/j.issn.1001-5256.2020.04.041. 刘嘉, 黄华. 肝硬化肌肉减少症的发病机制及诊治现状[J]. 临床肝胆病杂志, 2020, 36(4): 895-899. DOI: 10.3969/j.issn.1001-5256.2020.04.041.
[15]	DENT E, MORLEY JE, CRUZ-JENTOFT AJ, et al. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, diagnosis and management[J]. J Nutr Health Aging, 2018, 22(10): 1148-1161. DOI: 10.1007/s12603-018-1139-9.
[16]	WEBBORN JAD. ACSM's exercise management for persons with chronic diseases and disabilities[J]. Br J Sports Med, 1997, 31(4): 354. DOI: 10.1136/bjsm.31.4.354-b.
[17]	CHEN HW, DUNN MA. Arresting frailty and sarcopenia in cirrhosis: Future prospects[J]. Clin Liver Dis (Hoboken), 2018, 11(2): 52-57. DOI: 10.1002/cld.691.
[18]	European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024.
[19]	European Association for Study of Liver; Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis[J]. J Hepatol, 2015, 63(1): 237-264. DOI: 10.1016/j.jhep.2015.04.006.
[20]	SARIN SK, KUMAR M, LAU GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: A 2015 update[J]. Hepatol Int, 2016, 10(1): 1-98. DOI: 10.1007/s12072-015-9675-4.
[21]	PILLARD F, LAOUDJ-CHENIVESSE D, CARNAC G, et al. Physical activity and sarcopenia[J]. Clin Geriatr Med, 2011, 27(3): 449-470. DOI: 10.1016/j.cger.2011.03.009.
[22]	BACURAU AV, JANNIG PR, de MORAES WM, et al. Akt/mTOR pathway contributes to skeletal muscle anti-atrophic effect of aerobic exercise training in heart failure mice[J]. Int J Cardiol, 2016, 214: 137-147. DOI: 10.1016/j.ijcard.2016.03.071.
[23]	FAUSTINI-PEREIRA JL, HOMERCHER-GALANT L, GARCIA E, et al. Exercise capacity of cirrhotic patients with hepatopulmonary syndrome[J]. Ann Hepatol, 2015, 14(3): 361-368.
[24]	ZENITH L, MEENA N, RAMADI A, et al. Eight weeks of exercise training increases aerobic capacity and muscle mass and reduces fatigue in patients with cirrhosis[J]. Clin Gastroenterol Hepatol, 2014, 12(11): 1920-1926.e2. DOI: 10.1016/j.cgh.2014.04.016.
[25]	KERLING A, HARTUNG D, STUBBS B, et al. Impact of aerobic exercise on muscle mass in patients with major depressive disorder: A randomized controlled trial[J]. Neuropsychiatr Dis Treat, 2018, 14: 1969-1974. DOI: 10.2147/NDT.S167786.
[26]	XIANG Q, CHEN X, TAN GX, et al. Clinical observation of low-intensity exercise in patients with liver cirrhosis[J]. West China Med J, 2017, 32(9): 1370-1374. DOI: 10.7507/1002-0179.201606031. 向谦, 陈霞, 谭光秀, 等. 肝硬化患者低强度运动临床观察[J]. 华西医学, 2017, 32(9): 1370-1374. DOI: 10.7507/1002-0179.201606031.
[27]	AAMANN L, DAM G, BORRE M, et al. Resistance training increases muscle strength and muscle size in patients with liver cirrhosis[J]. Clin Gastroenterol Hepatol, 2020, 18(5): 1179-1187.e6. DOI: 10.1016/j.cgh.2019.07.058.
[28]	DEBETTE-GRATIEN M, TABOURET T, ANTONINI MT, et al. Personalized adapted physical activity before liver transplantation: Acceptability and results[J]. Transplantation, 2015, 99(1): 145-150. DOI: 10.1097/TP.0000000000000245.
[29]	PALOP MONTORO MV, PÁRRAGA MONTILLA JA, LOZANO AGUILERA E, et al. Sarcopenia intervention with progressive resistance training and protein nutritional supplements[J]. Nutr Hosp, 2015, 31(4): 1481-1490. DOI: 10.3305/nh.2015.31.4.8489.
[30]	DONG X, WANG XQ, WANG XH, et al. Research progress on molecular mechanism of skeletal muscle mass reduction in sarcopenia[J]. Chin J Gerontol, 2022, 42(3): 744-748. DOI: 10.3969/j.issn.1671-4695.2020.09.032. 董欣, 王小清, 王秀华, 等. 氧化应激在肌少症发生过程中作用的研究进展[J]. 中国老年学杂志, 2022, 42(3): 744-748. DOI: 10.3969/j.issn.1671-4695.2020.09.032.
[31]	SUMMERMATTER S, THURNHEER R, SANTOS G, et al. Remodeling of calcium handling in skeletal muscle through PGC-1α: Impact on force, fatigability, and fiber type[J]. Am J Physiol Cell Physiol, 2012, 302(1): C88-C99. DOI: 10.1152/ajpcell.00190.2011.
[32]	PADRÃO AI, FIGUEIRA AC, FAUSTINO-ROCHA AI, et al. Long-term exercise training prevents mammary tumorigenesis-induced muscle wasting in rats through the regulation of TWEAK signalling[J]. Acta Physiol (Oxf), 2017, 219(4): 803-813. DOI: 10.1111/apha.12721.
[33]	PIN F, BUSQUETS S, TOLEDO M, et al. Combination of exercise training and erythropoietin prevents cancer-induced muscle alterations[J]. Oncotarget, 2015, 6(41): 43202-43215. DOI: 10.18632/oncotarget.6439.
[34]	ELKINA Y, von HAEHLING S, ANKER SD, et al. The role of myostatin in muscle wasting: An overview[J]. J Cachexia Sarcopenia Muscle, 2011, 2(3): 143-151. DOI: 10.1007/s13539-011-0035-5.
[35]	YARASHESKI KE, BHASIN S, SINHA-HIKIM I, et al. Serum myostatin-immunoreactive protein is increased in 60-92 year old women and men with muscle wasting[J]. J Nutr Health Aging, 2002, 6(5): 343-348. http://www.researchgate.net/profile/Kevin_Yarasheski/publication/10998041_Serum_myostatin-immunoreactive_protein_is_increased_in_60-92_year_old_women_and_men_with_muscle_wasting/links/547c9b8c0cf27ed9786229f7/Serum-myostatin-immunoreactive-protein-is-increased-in-60-92-year-old-women-and-men-with-muscle-wasting.pdf
[36]	LENK K, ERBS S, HÖLLRIEGEL R, et al. Exercise training leads to a reduction of elevated myostatin levels in patients with chronic heart failure[J]. Eur J Prev Cardiol, 2012, 19(3): 404-411. DOI: 10.1177/1741826711402735.
[37]	KABAK B, BELVIRANLI M, OKUDAN N. Irisin and myostatin responses to acute high-intensity interval exercise in humans[J]. Horm Mol Biol Clin Investig, 2018, 35(3). DOI: 10.1515/hmbci-2018-0008.
[38]	KONOPKA AR, WOLFF CA, SUER MK, et al. Relationship between intermuscular adipose tissue infiltration and myostatin before and after aerobic exercise training[J]. Am J Physiol Regul Integr Comp Physiol, 2018, 315(3): R461-R468. DOI: 10.1152/ajpregu.00030.2018.
[39]	BUDUI SL, ROSSI AP, ZAMBONI M. The pathogenetic bases of sarcopenia[J]. Clin Cases Miner Bone Metab, 2015, 12(1): 22-26. DOI: 10.11138/ccmbm/2015.12.1.022.
[40]	GIELEN S, ADAMS V, MÖBIUS-WINKLER S, et al. Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic heart failure[J]. J Am Coll Cardiol, 2003, 42(5): 861-868. DOI: 10.1016/s0735-1097(03)00848-9.
[41]	EFFTING PS, BRESCIANINI S, SORATO HR, et al. Resistance exercise modulates oxidative stress parameters and TNF-α content in the heart of mice with diet-induced obesity[J]. Arq Bras Cardiol, 2019, 112(5): 545-552. DOI: 10.5935/abc.20190072.
[42]	CUNHA TF, BECHARA LR, BACURAU AV, et al. Exercise training decreases NADPH oxidase activity and restores skeletal muscle mass in heart failure rats[J]. J Appl Physiol (1985), 2017, 122(4): 817-827. DOI: 10.1152/japplphysiol.00182.2016.
[43]	PETROVSKI G, DAS DK. Does autophagy take a front seat in lifespan extension?[J]. J Cell Mol Med, 2010, 14(11): 2543-2551. DOI: 10.1111/j.1582-4934.2010.01196.x.
[44]	GELINO S, HANSEN M. Autophagy-an emerging anti-aging mechanism[J]. J Clin Exp Pathol, 2012, Suppl 4: 006. DOI: 10.4172/2161-0681.s4-006.
[45]	MOREIRA OC, ESTÉBANEZ B, MARTÍNEZ-FLOREZ S, et al. Mitochondrial function and mitophagy in the elderly: Effects of exercise[J]. Oxid Med Cell Longev, 2017, 2017: 2012798. DOI: 10.1155/2017/2012798.
[46]	WHITE Z, TERRILL J, WHITE RB, et al. Voluntary resistance wheel exercise from mid-life prevents sarcopenia and increases markers of mitochondrial function and autophagy in muscles of old male and female C57BL/6J mice[J]. Skelet Muscle, 2016, 6(1): 45. DOI: 10.1186/s13395-016-0117-3.
[47]	MACKENZIE MG, HAMILTON DL, MURRAY JT, et al. mVps34 is activated by an acute bout of resistance exercise[J]. Biochem Soc Trans, 2007, 35(Pt 5): 1314-1316. DOI: 10.1042/BST0351314.