肝硬化患者经颈静脉肝内门体分流术与肝硬化肌少症的关系

熊斌; 杨崇图

doi:10.3969/j.issn.1001-5256.2023.07.005

肝硬化患者经颈静脉肝内门体分流术与肝硬化肌少症的关系

DOI: 10.3969/j.issn.1001-5256.2023.07.005

熊斌^1, , ,,
杨崇图²

1.
广州医科大学附属第一医院介入科，广州 511407
2.
四川大学华西医院放射科，成都 610041

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：熊斌负责研究选题与终审论文；杨崇图负责撰写论文。

详细信息

通信作者:
熊斌，herrxiong@126.com (ORCID：0000-0002-7795-7041)

计量
- 文章访问数: 331
- HTML全文浏览量: 50
- PDF下载量: 86
- 被引次数: 0
出版历程
- 收稿日期: 2023-05-06
- 录用日期: 2023-06-06
- 出版日期: 2023-07-20

Association between transjugular intrahepatic portosystemic shunt and sarcopenia in patients with liver cirrhosis

Bin XIONG^{1
, ,
,},
Chongtu YANG²

1.
Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511407, China
2.
Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China

More Information

Corresponding author: XIONG Bin, herrxiong@126.com (ORCID: 0000-0002-7795-7041)

摘要

摘要: 肌肉减少症(肌少症)是肝硬化的常见并发症，与不良预后显著相关。经颈静脉肝内门体分流术(TIPS)是治疗肝硬化门静脉高压相关并发症的重要手段。基于现有研究证据，分析了肌少症与TIPS术后肝硬化患者各结局事件(肝性脑病、死亡)发生的关联，以及肌少症对于现有预后模型预测能力的改善价值；此外，分析了TIPS术后肌少症的改善及其对于肝硬化患者临床管理的意义。从现有报道综合分析发现：基线肌少症与TIPS术后不良预后有关，建议在TIPS术前基于影像学检查常规评估患者营养状况；TIPS术可改善部分患者的营养状况，使得肌少症逆转或改善达到一定程度并可转化为生存获益，故对于部分存在肌少症且病情稳定的肝硬化患者，经综合评估后可尽早行TIPS治疗。
- 肝硬化 /
- 门静脉高压 /
- 门体分流术, 经颈静脉肝内 /
- 肌减少症
Abstract: Sarcopenia is a common complication of liver cirrhosis and is significantly associated with poor prognosis. Transjugular intrahepatic portosystemic shunt (TIPS) is an important method for the treatment of portal hypertension and its complications. Based on current studies, this article analyzes the association between sarcopenia and the outcomes (hepatic encephalopathy and mortality) of patients with liver cirrhosis after TIPS and the value of improving the predictive ability of existing prognostic models for sarcopenia, as well as the improvement in sarcopenia after TIPS and its significance in the clinical management of patients with liver cirrhosis. A comprehensive analysis of existing reports show that baseline sarcopenia is associated with poor prognosis after TIPS, and it is thus recommended to evaluate nutritional status before TIPS based on radiological examination; TIPS can improve nutritional status and help to achieve reversal or improvement of sarcopenia to a certain extent, and it can also be translated into survival benefit. Therefore, for patients with sarcopenia and a relatively stable disease, TIPS can be performed as soon as possible after comprehensive evaluation.
- Liver Cirrhosis /
- Portal Hypertension /
- Portasystemic Shunt, Transjugular Intrahepatic /
- Sarcopenia

HTML全文

参考文献(42)

[1]	MERLI M, RIGGIO O, DALLY L. Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi)[J]. Hepatology, 1996, 23(5): 1041-1046. DOI: 10.1002/hep.510230516.
[2]	ALBERINO F, GATTA A, AMODIO P, et al. Nutrition and survival in patients with liver cirrhosis[J]. Nutrition, 2001, 17(6): 445-450. DOI: 10.1016/s0899-9007(01)00521-4.
[3]	LAI JC, TANDON P, BERNAL W, et al. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases[J]. Hepatology, 2021, 74(3): 1611-1644. DOI: 10.1002/hep.32049.
[4]	TANDON P, MONTANO-LOZA AJ, LAI JC, et al. Sarcopenia and frailty in decompensated cirrhosis[J]. J Hepatol, 2021, 75(Suppl 1): S147-S162. DOI: 10.1016/j.jhep.2021.01.025. PMID: 34039486.
[5]	BUNCHORNTAVAKUL C, REDDY KR. Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis[J]. Aliment Pharmacol Ther, 2020, 51(1): 64-77. DOI: 10.1111/apt.15571.
[6]	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. DOI: 10.1016/j.biocel.2013.05.019.
[7]	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.
[8]	DALLE S, ROSSMEISLOVA L, KOPPO K. The role of inflammation in age-related sarcopenia[J]. Front Physiol, 2017, 8: 1045. DOI: 10.3389/fphys.2017.01045.
[9]	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. DOI: 10.1210/jc.2003-030497.
[10]	LAKSHMAN KM, BHASIN S, CORCORAN C, et al. Measurement of myostatin concentrations in human serum: Circulating concentrations in young and older men and effects of testosterone administration[J]. Mol Cell Endocrinol, 2009, 302(1): 26-32. DOI: 10.1016/j.mce.2008.12.019.
[11]	GARCIA-TSAO G, ABRALDES JG, BERZIGOTTI A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1): 310-335. DOI: 10.1002/hep.28906.
[12]	de FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Corrigendum to 'Baveno VⅡ - Renewing consensus in portal hypertension'[J Hepatol (2022) 959-974][J]. J Hepatol, 2022, 77(1): 271. DOI: 10.1016/j.jhep.2022.03.024.
[13]	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.
[14]	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.
[15]	SU H, RUAN J, CHEN T, et al. CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis[J]. Cancer Imaging, 2019, 19(1): 82. DOI: 10.1186/s40644-019-0270-0.
[16]	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.
[17]	KONG M, GENG N, ZHOU Y, et al. Defining reference values for low skeletal muscle index at the L3 vertebra level based on computed tomography in healthy adults: A multicentre study[J]. Clin Nutr, 2022, 41(2): 396-404. DOI: 10.1016/j.clnu.2021.12.003.
[18]	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.
[19]	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. DOI: 10.1002/hep.30692.
[20]	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.
[21]	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.
[22]	PRAKTIKNJO M, BOOK M, LUETKENS J, et al. Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis[J]. Hepatology, 2018, 67(3): 1014-1026. DOI: 10.1002/hep.29602.
[23]	PRAKTIKNJO M, CLEES C, PIGLIACELLI A, et al. Sarcopenia is associated with development of acute-on-chronic liver failure in decompensated liver cirrhosis receiving transjugular intrahepatic portosystemic shunt[J]. Clin Transl Gastroenterol, 2019, 10(4): e00025. DOI: 10.14309/ctg.0000000000000025.
[24]	LI T, LIU J, ZHAO J, et al. Sarcopenia defined by psoas muscle thickness predicts mortality after transjugular intrahepatic portosystemic shunt[J]. Dig Dis Sci, 2023, 68(4): 1641-1652. DOI: 10.1007/s10620-022-07806-z.
[25]	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.
[26]	van VUGT J, ALFERINK L, BUETTNER S, et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort[J]. J Hepatol, 2018, 68(4): 707-714. DOI: 10.1016/j.jhep.2017.11.030.
[27]	BAI YW, LIU JC, YANG CT, et al. Inclusion of sarcopenia improves the prognostic value of MELD score in patients after transjugular intrahepatic portosystemic shunt[J]. Eur J Gastroenterol Hepatol, 2022, 34(9): 948-955. DOI: 10.1097/MEG.0000000000002391.
[28]	RONALD J, BOZDOGAN E, ZAKI IH, et al. Relative sarcopenia with excess adiposity predicts survival after transjugular intrahepatic portosystemic shunt creation[J]. AJR Am J Roentgenol, 2020, 214(1): 200-205. DOI: 10.2214/AJR.19.21655.
[29]	XIONG B, YANG C, ZHU X, et al. The added value of sarcopenia on existing risk scores to predict mortality after TIPS placement: A multicenter study[J]. Acad Radiol, 2023. DOI: 10.1016/j.acra.2023.03.011.[Online ahead of print]
[30]	BENMASSAOUD A, ROCCARINA D, ARICO F, et al. Sarcopenia does not worsen survival in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt for refractory ascites[J]. Am J Gastroenterol, 2020, 115(11): 1911-1914. DOI: 10.14309/ajg.0000000000000959.
[31]	XIONG B, YANG C, ZHOU C, et al. TIPS placement as the first-line therapy to prevent variceal rebleeding in patients with cirrhosis and sarcopenia[J]. Eur J Radiol, 2023, 158: 110630. DOI: 10.1016/j.ejrad.2022.110630.
[32]	PLAUTH M, SCHVTZ T, BUCKENDAHL DP, et al. Weight gain after transjugular intrahepatic portosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism[J]. J Hepatol, 2004, 40(2): 228-233. DOI: 10.1016/j.jhep.2003.10.011.
[33]	MONTOMOLI J, HOLLAND-FISCHER P, BIANCHI G, et al. Body composition changes after transjugular intrahepatic portosystemic shunt in patients with cirrhosis[J]. World J Gastroenterol, 2010, 16(3): 348-353. DOI: 10.3748/wjg.v16.i3.348.
[34]	TSIEN C, SHAH SN, MCCULLOUGH AJ, et al. Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent[J]. Eur J Gastroenterol Hepatol, 2013, 25(1): 85-93. DOI: 10.1097/MEG.0b013e328359a759.
[35]	ARTRU F, MIQUET X, AZAHAF M, et al. Consequences of TIPSS placement on the body composition of patients with cirrhosis and severe portal hypertension: a large retrospective CT-based surveillance[J]. Aliment Pharmacol Ther, 2020, 52(9): 1516-1526. DOI: 10.1111/apt.16080.
[36]	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.
[37]	EBADI M, WANG CW, LAI JC, et al. Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis[J]. J Cachexia Sarcopenia Muscle, 2018, 9(6): 1053-1062. DOI: 10.1002/jcsm.12349.
[38]	JAHANGIRI Y, PATHAK P, TOMOZAWA Y, et al. Muscle gain after transjugular intrahepatic portosystemic shunt creation: time course and prognostic implications for survival in cirrhosis[J]. J Vasc Interv Radiol, 2019, 30(6): 866-872. e4. DOI: 10.1016/j.jvir.2019.01.005.
[39]	GIOIA S, MERLI M, NARDELLI S, et al. The modification of quantity and quality of muscle mass improves the cognitive impairment after TIPS[J]. Liver Int, 2019, 39(5): 871-877. DOI: 10.1111/liv.14050.
[40]	LIU J, MA J, YANG C, et al. Sarcopenia in patients with cirrhosis after transjugular intrahepatic portosystemic shunt placement[J]. Radiology, 2022, 303(3): 711-719. DOI: 10.1148/radiol.211172.
[41]	LIU J, YANG C, YAO J, et al. Improvement of sarcopenia is beneficial for prognosis in cirrhotic patients after TIPS placement[J]. Dig Liver Dis, 2023. DOI: 10.1016/j.dld.2023.01.001.[Online ahead of print]
[42]	HUANG S, LIU J, CAI J, et al. Predictors of improvement of sarcopenia after transjugular intrahepatic portosystemic shunt creation in cirrhotic patients[J]. J Vasc Interv Radiol, 2023, 34(4): 639-644. DOI: 10.1016/j.jvir.2022.12.474.