肝硬化患者肌少症与脂质代谢异常的关系及经颈静脉肝内门体分流术干预的潜在益处

李秦念; 朱碧莲; 唐映梅; 张宸瑞

doi:10.12449/JCH250425

肝硬化患者肌少症与脂质代谢异常的关系及经颈静脉肝内门体分流术干预的潜在益处

DOI: 10.12449/JCH250425

昆明医科大学第二附属医院消化内科，昆明 650033

基金项目:

国家自然科学基金 (82360108);

云南省医学领军人才项目 (L-2019013)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：李秦念负责文章的构思及撰写；唐映梅负责文章的修改与指导；朱碧莲及张宸瑞协助文章的完成。

详细信息

通信作者:
唐映梅， tangyingmei_med@kmmu.edu.cn （ORCID： 0000-0002-0731-4198）

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出版历程
- 收稿日期: 2024-07-28
- 录用日期: 2024-08-13
- 出版日期: 2025-04-25

Association between sarcopenia and abnormal lipid metabolism in patients with liver cirrhosis and the potential benefits of transjugular intrahepatic portosystemic shunt

Department of Gastroenterology，The Second Affiliated Hospital of Kunming Medical University，Kunming 650033，China

Research funding:

National Natural Science Foundation of China (82360108);

Yunnan Leading Medical Talent Project (L-2019013)

More Information

Corresponding author: TANG Yingmei， tangyingmei_med@kmmu.edu.cn （ORCID： 0000-0002-0731-4198）

摘要

摘要: 随着肝硬化的进展，患者常常伴随出现肌少症和脂质代谢紊乱，两者之间的复杂相互作用不仅加剧了肝硬化的病程进展，还对患者的预后和生活质量产生了显著影响。而经颈静脉肝内门体分流术（TIPS）作为一种缓解肝硬化相关并发症的有效手段，通过改善肝脏血流动力学，降低门静脉压力，可以在一定程度上改善肌少症。此外，TIPS后血脂水平可能会发生不同程度的变化，这可能与肝脏的代谢功能恢复和血流动力学的改变密切相关。本文旨在介绍肝硬化、肌少症及脂质代谢异常之间的关系，阐述TIPS对肝硬化患者肌少症及脂质代谢异常的影响，探讨其机制及临床意义，为临床治疗提供理论依据。
- 肝硬化 /
- 肌减少症 /
- 脂代谢障碍 /
- 门体分流术，经颈静脉肝内
Abstract: With the progression of liver cirrhosis， patients often develop sarcopenia and lipid metabolism disorders， and the complex interaction between p sarcopenia and lipid metabolism disorders not only promotes the progression of liver cirrhosis， but also affects the prognosis and quality of life of patients. As an effective intervention for alleviating complications associated with liver cirrhosis， transjugular intrahepatic portosystemic shunt （TIPS） can improve sarcopenia to a certain degree by improving hepatic hemodynamics and reducing portal venous pressure. In addition， there might be varying degrees of changes in blood lipid levels after TIPS， which may be closely associated with the recovery of liver metabolic function and the alterations in hemodynamics. This article introduces the association between liver cirrhosis， sarcopenia， and lipid metabolism disorders， elaborates on the effect of TIPS on sarcopenia and abnormal lipid metabolism， and discusses related mechanism and clinical significance， in order to provide a theoretical basis for clinical treatment.
- Liver Cirrhosis /
- Sarcopenia /
- Lipid Metabolism Disorders /
- Portasystemic Shunt， Transjugular Intrahepatic

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参考文献(45)

[1]	Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006. 中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35( 11): 2408- 2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
[2]	DUDOV TR, SARITHALA VJ, KOROY PV, et al. Relationship between disorders of lipid profile and features of liver cirrhosis- an open prospective and comparative analysis of patients of stavropol territory in Russian federation[J]. J Clin Diagn Res, 2022, 16( 6):OC04-OC 10. DOI: 10.7860/jcdr/2022/53485.16426.
[3]	KIKUCHI N, UOJIMA H, HIDAKA H, et al. Prospective study for an independent predictor of prognosis in liver cirrhosis based on the new sarcopenia criteria produced by the Japan Society of Hepatology[J]. Hepatol Res, 2021, 51( 9): 968- 978. DOI: 10.1111/hepr.13698.
[4]	MAJEED T, SHARMA B, SHARMA R, et al. Sarcopenia in cirrhosis: Unraveling the prevalence and relationships with liver disease severity and complications[J]. Indian J Gastroenterol, 2024, 43( 4): 813- 820. DOI: 10.1007/s12664-024-01550-0.
[5]	TOPAN MM, SPOREA I, DĂNILĂ M, et al. Impact of sarcopenia on survival and clinical outcomes in patients with liver cirrhosis[J]. Front Nutr, 2021, 8: 766451. DOI: 10.3389/fnut.2021.766451.
[6]	TANTAI XX, LIU Y, YEO YH, et al. Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis[J]. J Hepatol, 2022, 76( 3): 588- 599. DOI: 10.1016/j.jhep.2021.11.006.
[7]	FENG RR, GUO XZ, KOU Y, et al. Association of lipid profile with decompensation, liver dysfunction, and mortality in patients with liver cirrhosis[J]. Postgrad Med, 2021, 133( 6): 626- 638. DOI: 10.1080/00325481.2021.1930560.
[8]	DHALIWAL A, ARMSTRONG MJ. Sarcopenia in cirrhosis: A practical overview[J]. Clin Med(Lond), 2020, 20( 5): 489- 492. DOI: 10.7861/clinmed.2020-0089.
[9]	KUMAR R, PRAKASH SS, PRIYADARSHI RN, et al. Sarcopenia in chronic liver disease: A metabolic perspective[J]. J Clin Transl Hepatol, 2022, 10( 6): 1213- 1222. DOI: 10.14218/JCTH.2022.00239.
[10]	TRAUB J, REISS L, ALIWA B, et al. Malnutrition in patients with liver cirrhosis[J]. Nutrients, 2021, 13( 2): 540. DOI: 10.3390/nu13020540.
[11]	REN XJ, HAO SS, YANG CL, et al. Alterations of intestinal microbiota in liver cirrhosis with muscle wasting[J]. Nutrition, 2021, 83: 111081. DOI: 10.1016/j.nut.2020.111081.
[12]	JIANG HL, PENG Y, ZHANG W, et al. Gut microbiome-targeted therapies in liver cirrhosis: A protocol for systematic review and meta-analysis[J]. Syst Rev, 2022, 11( 1): 181. DOI: 10.1186/s13643-022-02059-3.
[13]	XU JQ, PAN YK, ZHANG JX, et al. Sarcopenia in liver cirrhosis: Perspectives from epigenetics and microbiota[J]. Front Med(Lausanne), 2023, 10: 1264205. DOI: 10.3389/fmed.2023.1264205.
[14]	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.
[15]	DING HR, WANG JL, REN HZ, et al. Lipometabolism and glycometabolism in liver diseases[J]. Biomed Res Int, 2018, 2018: 1287127. DOI: 10.1155/2018/1287127.
[16]	KANO N, WANT EJ, MCPHAIL MJW. Metabolomics in advanced liver disease[J]. Curr Treat Options Gastroenterol, 2021, 19( 2): 380- 397. DOI: 10.1007/s11938-021-00347-w.
[17]	YAMUNA J, AKILA A, MURUGANANDAM VU, et al. Lipid profile as an indicator of severity in cirrhosis of liver: Hospital based cross-sectional study[J]. J Assoc Physicians India, 2023, 71( 3): 11- 12. DOI: 10.5005/japi-11001-0210.
[18]	SHI CC, LIU YJ, ZHANG RN, et al. Dyslipidemia in patients with liver cirrhosis[J]. Prac Hepatol, 2021, 24( 6): 859- 862. DOI: 10.3969/j.issn.1672-5069.2021.06.023. 石翠翠, 刘彦君, 章瑞南, 等. 肝硬化患者血脂异常分析[J]. 实用肝脏病杂志, 2021, 24( 6): 859- 862. DOI: 10.3969/j.issn.1672-5069.2021.06.023.
[19]	HOVE M TEN, PATER L, STORM G, et al. The hepatic lipidome: From basic science to clinical translation[J]. Adv Drug Deliv Rev, 2020, 159: 180- 197. DOI: 10.1016/j.addr.2020.06.027.
[20]	KIM H, PARK C, KIM TH. Targeting liver X receptors for the treatment of non-alcoholic fatty liver disease[J]. Cells, 2023, 12( 9): 1292. DOI: 10.3390/cells12091292.
[21]	CLÀRIA J, CURTO A, MOREAU R, et al. Untargeted lipidomics uncovers lipid signatures that distinguish severe from moderate forms of acutely decompensated cirrhosis[J]. J Hepatol, 2021, 75( 5): 1116- 1127. DOI: 10.1016/j.jhep.2021.06.043.
[22]	SHOAIB N, KHAN Z, IBRAHIM M, et al. Dyslipidemia and impaired liver function biomarkers in patients with hepatitis B liver cirrhosis[J]. J Taibah Univ Med Sci, 2023, 18( 4): 748- 754. DOI: 10.1016/j.jtumed.2023.01.002.
[23]	CHEN WQ, FANG Y, WANG WL, et al. Relationships between upper gastrointestinal bleeding,blood lipid level and Hp infection in cirrhosis patients[J]. J Trop Med, 2023, 23( 3): 360- 363, 429. DOI: 10.3969/j.issn.1672-3619.2023.03.017. 陈凤琴, 方园, 王万亮, 等. 肝硬化患者上消化道出血与血脂水平及Hp感染的关系[J]. 热带医学杂志, 2023, 23( 3): 360- 363, 429. DOI: 10.3969/j.issn.1672-3619.2023.03.017.
[24]	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.
[25]	SAEDI A AL, DEBRUIN DA, HAYES A, et al. Lipid metabolism in sarcopenia[J]. Bone, 2022, 164: 116539. DOI: 10.1016/j.bone.2022.116539.
[26]	HAN YQ, SUN QW, CHEN W, et al. New advances of adiponectin in regulating obesity and related metabolic syndromes[J]. J Pharm Anal, 2024, 14( 5): 100913. DOI: 10.1016/j.jpha.2023.12.003.
[27]	CHOI KM. The impact of organokines on insulin resistance, inflammation, and atherosclerosis[J]. Endocrinol Metab(Seoul), 2016, 31( 1): 1- 6. DOI: 10.3803/EnM.2016.31.1.1.
[28]	LIU CR, CHENG KY, TONG X, et al. The role of obesity in sarcopenia and the optimal body composition to prevent against sarcopenia and obesity[J]. Front Endocrinol(Lausanne), 2023, 14: 1077255. DOI: 10.3389/fendo.2023.1077255.
[29]	KARLSEN A, MACKEY AL, SUETTA C, et al. What is the impact of acute inflammation on muscle performance in geriatric patients?[J]. Exp Gerontol, 2020, 138: 111008. DOI: 10.1016/j.exger.2020.111008.
[30]	LI CW, YU K, SHYH-CHANG N, et al. Pathogenesis of sarcopenia and the relationship with fat mass: Descriptive review[J]. J Cachexia Sarcopenia Muscle, 2022, 13( 2): 781- 794. DOI: 10.1002/jcsm.12901.
[31]	YAMAMOTO S, HONMA K, FUJII M, et al. SHRSP5/Dmcr rats fed a high-fat and high-cholesterol diet develop disease-induced sarcopenia as nonalcoholic steatohepatitis progresses[J]. Ann Anat, 2023, 249: 152104. DOI: 10.1016/j.aanat.2023.152104.
[32]	LIN WM, SONG HB, SHEN JQ, et al. Functional role of skeletal muscle-derived interleukin-6 and its effects on lipid metabolism[J]. Front Physiol, 2023, 14: 1110926. DOI: 10.3389/fphys.2023.1110926.
[33]	RYU H, JEONG HH, LEE S, et al. LPS-induced modifications in macrophage transcript and secretion profiles are linked to muscle wasting and glucose intolerance[J]. J Microbiol Biotechnol, 2024, 34( 2): 270- 279. DOI: 10.4014/jmb.2309.09037.
[34]	WANG M, YANG ZH, ZHAI HM. Association of high-density lipoprotein cholesterol with sarcopenia in Chinese community-dwelling middle-aged and older adults: Evidence from 4-year longitudinal study[J]. Gerontology, 2024, 70( 8): 812- 822. DOI: 10.1159/000538980.
[35]	GHZAIEL I, ZARROUK A, PIRES V, et al. 7β-hydroxycholesterol and 7-ketocholesterol: New oxidative stress biomarkers of sarcopenia inducing cytotoxic effects on myoblasts and myotubes[J]. J Steroid Biochem Mol Biol, 2023, 232: 106345. DOI: 10.1016/j.jsbmb.2023.106345.
[36]	MCCULLOUGH D, WEBB R, ENRIGHT KJ, et al. How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabolic and cardiovascular health[J]. Rev Endocr Metab Disord, 2021, 22( 2): 389- 405. DOI: 10.1007/s11154-020-09616-y.
[37]	WANG CY, HE FL, WANG Y. North American Practice-Based Recommendations for transjugular intrahepatic portosystemic shunts in portal hypertension[J]. J Prac Hepatol, 2022, 25( 4): 609- 610. DOI: 10.3969/j.issn.1672-5069.2022.04.039. 汪春雨, 何福亮, 王宇. 经颈静脉肝内门体静脉分流术临床实践指南推荐意见[J]. 实用肝脏病杂志, 2022, 25( 4): 609- 610. DOI: 10.3969/j.issn.1672-5069.2022.04.039.
[38]	GIRI S, ANIRVAN P, CHAUDHARY M, et al. Impact of nutritional status on the outcome of transjugular intrahepatic portosystemic shunt in patients with cirrhosis: A systematic review[J]. Br J Radiol, 2024, 97( 1154): 331- 340. DOI: 10.1093/bjr/tqad065.
[39]	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.
[40]	XIONG B, YANG CT. Association between transjugular intrahepatic portosystemic shunt and sarcopenia in patients with liver cirrhosis[J]. J Clin Hepatol, 2023, 39( 7): 1541- 1546. DOI: 10.3969/j.issn.1001-5256.2023.07.005. 熊斌, 杨崇图. 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[J]. 临床肝胆病杂志, 2023, 39( 7): 1541- 1546. DOI: 10.3969/j.issn.1001-5256.2023.07.005.
[41]	CURRIE BM, BAKHTIAR M, NADOLSKI GJ, et al. Mitigation of sarcopenia after peritoneovenous shunt placement in patients with refractory ascites[J]. J Vasc Interv Radiol, 2023, 34( 4): 633- 638. DOI: 10.1016/j.jvir.2022.12.037.
[42]	AHMED Z, BADAL J, GANGWANI MK, et al. Sarcopenia is a risk factor for post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy and mortality: A systematic review and meta-analysis[J]. Indian J Gastroenterol, 2024, 43( 4): 748- 759. DOI: 10.1007/s12664-023-01465-2.
[43]	LIU JC, MA JQ, YANG CT, 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.
[44]	DELGADO MG, MERTINEIT N, BOSCH J, et al. Combination of Model for End-Stage Liver Disease(MELD) and Sarcopenia predicts mortality after transjugular intrahepatic portosystemic shunt(TIPS)[J]. Dig Liver Dis, 2024, 56( 9): 1544- 1550. DOI: 10.1016/j.dld.2024.03.003.
[45]	BALLESTER MP, LLUCH P, TOSCA J, et al. Serum cholesterol predicts transplant-free survival in cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt[J]. Dig Liver Dis, 2021, 53( 12): 1596- 1602. DOI: 10.1016/j.dld.2021.04.035.