肝硬化患者肌肉减少症与肝性脑病的关系

朱伊静; 李伟; 赵守松

doi:10.3969/j.issn.1001-5256.2023.03.030

肝硬化患者肌肉减少症与肝性脑病的关系

DOI: 10.3969/j.issn.1001-5256.2023.03.030

蚌埠医学院第一附属医院感染科，安徽蚌埠 233000

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：朱伊静负责课题设计，资料分析，撰写论文；李伟参与收集数据，修改论文；赵守松负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
李伟，liwei79722.student@sina.com (ORCID: 0000-0002-1659-4910)

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出版历程
- 收稿日期: 2022-07-23
- 录用日期: 2022-08-25
- 出版日期: 2023-03-20

Research advances in the association between sarcopenia and hepatic encephalopathy in patients with liver cirrhosis

Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China

More Information

Corresponding author: LI Wei, liwei79722.student@sina.com (ORCID: 0000-0002-1659-4910)

摘要

摘要: 肌肉减少症(简称肌少症)是肝硬化患者营养不良的表现形式之一。大多数研究表明，肌少症与显性肝性脑病导致肝硬化患者生活质量下降、临床预后不良甚至死亡等事件风险增加，但关于肌少症与轻微性肝性脑病之间的关系研究不多。通过对肌少症与肝性脑病的相关研究进展进行综述，指出改善患者的营养状况可预防轻微性肝性脑病发生，甚至降低显性肝性脑病的发生，从而改善患者预后，提高生存质量，降低死亡风险。
- 肝硬化 /
- 肌减少症 /
- 肝性脑病
Abstract: Sarcopenia is one of the manifestations of malnutrition in patients with liver cirrhosis. Most studies have shown that sarcopenia is associated with overt hepatic encephalopathy (OHE), leading to an increased risk of events such as reduced quality of life, poor clinical prognosis, and even death in patients with liver cirrhosis, but there are few studies on the association between sarcopenia and minimal hepatic encephalopathy (MHE). This article reviews the research advances in sarcopenia and hepatic encephalopathy to provide a reliable basis for clinical treatment, and it is pointed out that the nutritional status of patients can be improved to prevent MHE and even reduce the onset of OHE, thereby improving patient prognosis, increasing quality of life, and reducing the risk of death.
- Liver Cirrhosis /
- Sarcopenia /
- Hepatic Encephalopathy

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参考文献(41)

[1]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of hepatic encephalopathy in cirrhosis[J]. J Clin Hepatol, 2018, 34(10): 2076-2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007. 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南[J]. 临床肝胆病杂志, 2018, 34(10): 2076-2089. DOI: 10.3969/j.issn.1001-5256.2018.10.007.
[2]	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 (Baltimore, Md.), 2019, 70(5): 1704-1713. DOI: 10.1002/hep.30692.
[3]	BHANJI R A, 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.
[4]	XU CQ, MOHAMAD Y, KAPPUS MR, et al. The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study[J]. Liver Int, 2021, 41(10): 2467-2473. DOI: 10.1111/liv.15006.
[5]	HAN F, HAN T, LIANG J. Assessment and clinical management of sarcopenia in patients with liver cirrhosis[J]. J Clin Hepatol, 2019, 35(4): 891-894. DOI: 10.3969/j.issn.1001-5256.2019.04.041. 韩芳, 韩涛, 梁静. 肝硬化患者肌少症的评估与临床管理[J]. 临床肝胆病杂志, 2019, 35(4): 891-894. DOI: 10.3969/j.issn.1001-5256.2019.04.041.
[6]	CRUZ-JENTOFT AJ, BAHAT G, BAUER J, et al. Sarcopenia: revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(1): 16-31. DOI: 10.1093/ageing/afy169.
[7]	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.
[8]	SHARMA P, RAUF A, MATIN A, et al. Handgrip strength as an important bed side tool to assess malnutrition in patient with liver disease[J]. J Clin Exp Hepatol, 2017, 7(1): 16-22. DOI: 10.1016/j.jceh.2016.10.005.
[9]	WU SW, WU SF, LIANG HW, et al. Measuring factors affecting grip strength in a Taiwan Chinese population and a comparison with consolidated norms[J]. Appl Ergon, 2009, 40(4): 811-815. DOI: 10.1016/j.apergo.2008.08.006.
[10]	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. DOI: 10.1016/j.jamda.2013.11.025.
[11]	LIU LK, LEE WJ, LIU CL, et al. Age-related skeletal muscle mass loss and physical performance in Taiwan: implications to diagnostic strategy of sarcopenia in Asia[J]. Geriatr Gerontol Int, 2013, 13(4): 964-971. DOI: 10.1111/ggi.12040.
[12]	Chinese Medical Association, Osteoporosis and Bone Mineral Salt Diseases Branch. Sarcopenia consensus[J]. Chin J Osteoporosis Bone Miner Res, 2016, 9(3): 215-227. DOI: 10.3969/j.issn.1674-2591.2016.03.001. 中华医学会骨质疏松和骨矿盐疾病分会. 肌少症共识[J]. 中华骨质疏松和骨矿盐疾病杂志, 2016, 9(3): 215-227. DOI: 10.3969/j.issn.1674-2591.2016.03.001.
[13]	DURAND F, BUYSE S, FRANCOZ C, et al. Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography[J]. J Hepatol, 2014, 60(6): 1151-1157. DOI: 10.1016/j.jhep.2014.02.026.
[14]	VELLAS B, FIELDING RA, BENS C, et al. Implications of ICD-10 for sarcopenia clinical practice and clinical trials: Report by the international conference on frailty and sarcopenia research task force[J]. J Frailty Aging, 2018, 7(1): 2-9. DOI: 10.14283/jfa.2017.30.
[15]	LOCQUET M, BEAUDART C, PETERMANS J, et al. EWGSOP2 versus EWGSOP1: Impact on the prevalence of sarcopenia and its major health consequences[J]. J Am Med Dir Assoc, 2019, 20(3): 384-385. DOI: 10.1016/j.jamda.2018.11.027.
[16]	CAREY EJ, LAI JC, SONNENDAY C, et al. A north american expert opinion statement on sarcopenia in liver transplantation[J]. Hepatology, 2019, 70(5): 1816-1829. DOI: 10.1002/hep.30828.
[17]	STEGENGA H, HAINES A, JONES K, et al. Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance[J]. BMJ, 2014, 349: g6608. DOI: 10.1136/bmj.g6608.
[18]	WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies[J]. Lancet, 2004, 363(9403): 157-163. DOI: 10.1016/S0140-6736(03)15268-3.
[19]	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.
[20]	ANAND A, MOHTA S, AGARWAL S, et al. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria with population-based skeletal muscle index best predicts mortality in asians with cirrhosis[J]. J Clin Exp Hepatol, 2022, 12(1): 52-60. DOI: 10.1016/j.jceh.2021.03.015.
[21]	HOU L, DENG Y, FAN X, et al. A sex-stratified prognostic nomogram incorporating body compositions for long-term mortality in cirrhosis[J]. JPEN J Parenter Enteral Nutr, 2021, 45(2): 403-413. DOI: 10.1002/jpen.1841.
[22]	XU M, LI T, KONG M, et al. Psoas muscle index can be used to predict long-term mortality in young male patients with acute-on-chronic liver failure[J]. Front Nutr, 2022, 9: 811826. DOI: 10.3389/fnut.2022.811826.
[23]	FUJIWARA N, NAKAGAWA H, KUDO Y, et al. Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma[J]. J Hepatol, 2015, 63(1): 131-140. DOI: 10.1016/j.jhep.2015.02.031.
[24]	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.
[25]	CHANG KV, CHEN JD, WU WT, et al. Is sarcopenia associated with hepatic encephalopathy in liver cirrhosis? A systematic review and meta-analysis[J]. J Formos Med Assoc, 2019, 118(4): 833-842. DOI: 10.1016/j.jfma.2018.09.011.
[26]	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.
[27]	AGRAWAL S, UMAPATHY S, DHIMAN RK. Minimal hepatic encephalopathy impairs quality of life[J]. J Clin Exp Hepatol, 2015, 5(Suppl 1): S42-S48. DOI: 10.1016/j.jceh.2014.11.006.
[28]	BAJAJ JS, WADE JB, GIBSON DP, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers[J]. Am J Gastroenterol, 2011, 106(9): 1646-1653. DOI: 10.1038/ajg.2011.157.
[29]	MERLI M, GIUSTO M, LUCIDI C, et al. Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: results of a prospective study[J]. Metab Brain Dis, 2013, 28(2): 281-284. DOI: 10.1007/s11011-012-9365-z.
[30]	HANAI T, SHIRAKI M, WATANABE S, et al. Sarcopenia predicts minimal hepatic encephalopathy in patients with liver cirrhosis[J]. Hepatol Res, 2017, 47(13): 1359-1367. DOI: 10.1111/hepr.12873.
[31]	NARDELLI S, RIGGIO O, GIOIA S, et al. Risk factors for hepatic encephalopathy and mortality in cirrhosis: The role of cognitive impairment, muscle alterations and shunts[J]. Dig Liver Dis, 2022, 54(8): 1060-1065. DOI: 10.1016/j.dld.2021.12.015.
[32]	HANAI T, NISHIMURA K, MIWA T, et al. Usefulness of nutritional therapy recommended in the Japanese Society of Gastroenterology/Japan Society of Hepatology evidence-based clinical practice guidelines for liver cirrhosis 2020[J]. J Gastroenterol, 2021, 56(10): 928-937. DOI: 10.1007/s00535-021-01821-z.
[33]	NARDELLI S, GIOIA S, PASQUALE C, et al. Cognitive impairment predicts the occurrence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt[J]. Am J Gastroenterol, 2016, 111(4): 523-528. DOI: 10.1038/ajg.2016.29.
[34]	CAI W, LIN H, QI R, et al. Psoas muscle density predicts occurrences of hepatic encephalopathy in patients receiving transjugular intrahepatic portosystemic shunts within 1 year[J]. Cardiovasc Intervent Radiol, 2022, 45(1): 93-101. DOI: 10.1007/s00270-021-02961-8.
[35]	GIOIA S, RIDOLA L, CRISTOFARO L, et al. The improvement in body composition including subcutaneous and visceral fat reduces ammonia and hepatic encephalopathy after transjugular intrahepatic portosystemic shunt[J]. Liver Int, 2021, 41(12): 2965-2973. DOI: 10.1111/liv.15060.
[36]	YANG C, ZHU X, LIU J, et al. Development and validation of prognostic models to estimate the risk of overt hepatic encephalopathy after TIPS creation: A multicenter study[J]. Clin Transl Gastroenterol, 2022, 13(3): e00461. DOI: 10.14309/ctg.0000000000000461.
[37]	ZENG X, SHI ZW, YU JJ, et al. Sarcopenia as a prognostic predictor of liver cirrhosis: a multicentre study in China[J]. J Cachexia Sarcopenia Muscle, 2021, 12(6): 1948-1958. DOI: 10.1002/jcsm.12797.
[38]	KUMAR A, DAVULURI G, SILVA RNE, et al. Ammonia lowering reverses sarcopenia of cirrhosis by restoring skeletal muscle proteostasis[J]. Hepatology, 2017, 65(6): 2045-2058. DOI: 10.1002/hep.29107.
[39]	EBADI M, TSIEN C, BHANJI RA, et al. Skeletal muscle pathological fat infiltration (myosteatosis) is associated with higher mortality in patients with cirrhosis[J]. Cells, 2022, 11(8): 1345. DOI: 10.3390/cells11081345.
[40]	MIWA T, HANAI T, NISHIMURA K, et al. Survival benefit of l-carnitine supplementation in patients with cirrhosis[J]. JPEN J Parenter Enteral Nutr, 2022, 46(6): 1326-1334. DOI: 10.1002/jpen.2386.
[41]	IACOB S, MINA V, MANDEA M, et al. Assessment of sarcopenia related quality of life using SarQoL^Ⓡ questionnaire in patients with liver cirrhosis[J]. Front Nutr, 2022, 9: 774044. DOI: 10.3389/fnut.2022.774044.