肝硬化患者肌少症的发生机制及诊疗进展
DOI: 10.3969/j.issn.1001-5256.2023.09.025
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摘要: 肌少症是一种因年龄增长导致肌肉进行性、广泛性下降的疾病。随着研究的深入,发现其与多种慢性病有关,其中在肝硬化患者中因蛋白质摄入减少、分解代谢失衡、自身合成不足等原因,发病率极高,与患者治疗效果、远期生存呈负相关,是肝硬化患者预后不良的独立危险因素。因此,积极干预肌少症对肝硬化患者具有重要的临床价值。本文从定义、诊断、发病机制、临床影响、治疗等方面综述肝硬化与肌少症之间的关系。Abstract: Sarcopenia is a progressive and generalized muscle loss due to aging. With the deepening of research, it is found to be related to many chronic diseases. In patients with liver cirrhosis, owing to reduced protein intake, catabolism imbalance, insufficient self synthesis, and other reasons, the incidence of sarcopenia is extremely high, which negatively affects the treatment outcome and long-term survival, so it is an independent risk factor for poor prognosis in patients with liver cirrhosis. Therefore, it has important clinical value to manage sarcopenia in patients with liver cirrhosis. This review will explain the relationship between liver cirrhosis and sarcopenia from the aspects of definition, diagnosis, pathogenesis, clinical impact, and treatment.
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Key words:
- Liver Cirrhosis /
- Sarcopenia /
- Diagnosis
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表 1 肌少症诊断标准的区别
Table 1. Diagnostic difference of sarcopenia
诊断类型 AWGS(2019) EWGSOP2(2019) 肌少症(前期)的诊断 低肌力或低体能 低肌力 肌少症的诊断 低肌量+低肌力或低体能 低肌量+低肌力 严重肌少症的诊断 低肌量+低肌力+低体能 低肌量+低肌力+低体能 表 2 AWGS(2019)和EWGSOP2(2019)肌少症的常用工具诊断标准
Table 2. Common diagnostic criteria of AWGS (2019) and EWGSOP2 (2019) for sarcopenia
检测内容 检测工具 AWGS(2019) EWGSOP2(2019) 男 女 男 女 肌量测定 CT <36.5 cm2/m2[3] <30.2 cm2/m2[3] <52.4 cm2/m2[4] <38.5 cm2/m2[4] BIA <7.0 kg/m2[5] <5.7 kg/m2[5] <7.0 kg/m2[6] <5.5 kg/m2[6] DEXA <7.0 kg/m2[5] <5.4 kg/m2[5] <7.0 kg/m2[6] <5.5 kg/m2[6] 肌力测定 握力器 <28 kg[5] <18 kg[5] <27 kg[6] <16 kg[6] 5次椅立测试 ≥12 s[5] ≥15 s[6] 身体活动功能 步速测试 ≤1 m/s[5] ≤0.8 m/s[6] SPPB ≤9分[5] ≤8分[6] 注:亚洲标准采用6 m步速测定实验,欧洲标准采用4 m步速测定实验。 -
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