Value of L3 skeletal muscle index in nutritional diagnosis of end-stage liver disease
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摘要: 终末期肝病患者因营养摄入减少、能量消耗增加、禁食适应性受损、肝糖原储备减少、蛋白质消耗增加常导致营养不良。第三腰椎骨骼肌指数(L3-SMI)(第三腰椎横断面肌肉的面积/身高平方)是反映终末期肝病营养不良的重要指标,具有客观性强、受水钠潴留影响小、可重复性好等优点。回顾了L3-SMI在肝硬化、肝衰竭、肝癌和接受肝移植患者营养不良诊断的相关研究。分析表明,L3-SMI可系统评估终末期肝病患者营养状况和营养干预的效果,有望成为终末期肝病营养诊断的重要手段。Abstract: Patients with end-stage liver disease often have malnutrition caused by reduced nutrient intake, increased energy consumption, impaired fasting adaptability, reduced liver glycogen reserve, and increased protein consumption. L3 skeletal muscle index (L3-SMI) (skeletal muscle cross-sectional area at the level of L3/square of height) is an important indicator for evaluating malnutrition in end-stage liver disease, with the advantages of strong objectivity, little influence by water-sodium retention, and good repeatability. This article reviews the application of L3-SMI in the nutritional diagnosis of liver cirrhosis, liver failure, liver cancer, and liver transplantation. The analysis shows that L3-SMI can effectively evaluate nutritional status and the effect of nutritional intervention in patients with end-stage liver disease, and therefore, it is expected to become an important method for nutritional diagnosis in end-stage liver disease.
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Key words:
- End Stage Liver Disease /
- Malnutrition /
- Body Composition /
- Diagnosis /
- Prognosis
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[1] Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association. Clinical guidelines on nutrition in end-stage liver disease[J]. J Clin Hepatol, 2019, 35(6): 1222-1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010.中华医学会肝病学分会, 中华医学会消化病学分会. 终末期肝病临床营养指南[J]. 临床肝胆病杂志, 2019, 35(6): 1222-1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010. [2] PLAUTH M, BERNAL W, DASARATHY S, et al. ESPEN guideline on clinical nutrition in liver disease[J]. Clin Nutr, 2019, 38(2): 485-521. DOI: 10.1016/j.clnu.2018.12.022. [3] 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. [4] SINCLAIR M, GOW PJ, GROSSMANN M, et al. Review article: Sarcopenia in cirrhosis—aetiology, implications and potential therapeutic interventions[J]. Aliment Pharmacol Ther, 2016, 43(7): 765-777. DOI: 10.1111/apt.13549. [5] KAZEMI-BAJESTANI SMR, MAZURAK VC, BARACOS V. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes[J]. Seminars in cell & developmental biology, 2016, 54: 2-10. DOI: 10.1016/j.semcdb.2015.09.001. [6] LINDQVIST C, BRISMAR TB, MAJEED A, et al. Assessment of muscle mass depletion in chronic liver disease: Dual-energy x-ray absorptiometry compared with computed tomography[J]. Nutrition, 2019, 61: 93-98. DOI: 10.1016/j.nut.2018.10.031. [7] LI TZ, KONG M, CHEN Y. Association between end-stage liver disease and sarcopenia[J]. J Clin Hepatol, 2020, 36(3): 693-696. DOI: 10.3969/j.issn.1001-5256.2020.03.050.李侗曾, 孔明, 陈煜. 终末期肝病与肌少症的关系[J]. 临床肝胆病杂志, 2020, 36(3): 693-696. DOI:10. 3969/j.issn.1001-5256.2020.03.050. [8] REN X, HAO S, YANG C, et al. Alterations of intestinal microbiota in liver cirrhosis with muscle wasting[J]. Nutrition, 2020, 83: 111081. DOI: 10.1016/j.nut.2020.111081. [9] EBADI M, BHANJI RA, DUNICHAND-HOEDL AR, et al. Sarcopenia severity based on computed tomography image analysis in patients with cirrhosis[J]. Nutrients, 2020, 12(11): 3463. DOI: 10.3390/nu12113463. [10] NAMBA M, HIRAMATSU A, AIKATA H, et al. Management of refractory ascites attenuates muscle mass reduction and improves survival in patients with decompensated cirrhosis[J]. J Gastroenterol, 2020, 55(2): 217-226. DOI: 10.1007/s00535-019-01623-4. [11] 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. [12] TATEYAMA M, NAOE H, TANAKA M, et al. Loss of skeletal muscle mass affects the incidence of minimal hepatic encephalopathy: A case control study[J]. BMC Gastroenterol, 2020, 20(1): 371. DOI: 10.1186/s12876-020-01501-x. [13] 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. [14] 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. [15] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure (2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007. [16] LI L, CHEN Y. The recent research progress in nutritional assessment and intervention treatment of liver failure in patients[J]. Chin J Hepatol, 2017, 25(7): 548-552. DOI: 10.3760/cma.j.issn.1007-3418.2017.07.017.李璐, 陈煜. 肝衰竭患者的营养评估及营养干预研究进展[J]. 中华肝脏病杂志, 2017, 25(7): 548-552. DOI: 10.3760/cma.j.issn.1007-3418.2017.07.017. [17] LI TZ, KONG M, SONG WY, et al. Relationship between skeletal muscle index of third lumbar vertebrae and clinical characteristics in patients with acute on chronic liver failure[J]. J Practical Hepatol, 2020, 23(4): 467-470. DOI: 10.3969/j.issn.1672-5069.2020.04.004.李侗曾, 孔明, 宋文艳, 等. 慢加急性肝衰竭患者第三腰椎骨骼肌指数与临床指标的关系[J]. 实用肝脏病杂志, 2020, 23(4): 467-470. DOI: 10.3969/j.issn.1672-5069.2020.04.004. [18] SHACHAR SS, WILLIAMS GR, MUSS HB, et al. Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review[J]. Eur J Cancer, 2016, 57: 58-67. DOI: 10.1016/j.ejca.2015.12.030. [19] YABUSAKI N, FUJII T, YAMADA S, et al. Adverse impact of low skeletal muscle index on the prognosis of hepatocellular carcinoma after hepatic resection[J]. Int J Surg, 2016, 30: 136-142. DOI: 10.1016/j.ijsu.2016.04.049. [20] BERARDI G, ANTONELLI G, COLASANTI M, et al. Association of sarcopenia and body composition with short-term outcomes after liver resection for malignant tumors[J]. JAMA surgery, 2020, 155(11): e203336. DOI: 10.1001/jamasurg.2020.3336. [21] KOBAYASHI T, KAWAI H, NAKANO O, et al. Rapidly declining skeletal muscle mass predicts poor prognosis of hepatocellular carcinoma treated with transcatheter intra-arterial therapies[J]. BMC Cancer, 2018, 18(1): 756. DOI: 10.1186/s12885-018-4673-2. [22] UOJIMA H, CHUMA M, TANAKA Y, et al. Skeletal muscle mass influences tolerability and prognosis in hepatocellular carcinoma patients treated with lenvatinib[J]. Liver Cancer, 2020, 9(2): 193-206. DOI: 10.1159/000504604. [23] UCHIKAWA S, KAWAOKA T, NAMBA M, et al. Skeletal muscle loss during tyrosine kinase inhibitor treatment for advanced hepatocellular carcinoma patients[J]. Liver Cancer, 2020, 9(2): 148-155. DOI: 10.1159/000503829. [24] 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. [25] GOLSE N, BUCUR PO, CIACIO O, et al. A new definition of sarcopenia in patients with cirrhosis undergoing liver transplantation[J]. Liver Transpl, 2017, 23(2): 143-154. DOI: 10.1002/lt.24671. [26] KAMO N, KAIDO T, MIYACHI Y, et al. Preoperative abnormal body composition is closely related to bacteremia after living donor liver transplantation[J]. Nutrition, 2020, 77: 110798. DOI: 10.1016/j.nut.2020.110798.
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