肝硬化患者肌少症的发生机制及诊疗进展

张兴会; 郑梦瑶; 杨晋辉

doi:10.3969/j.issn.1001-5256.2023.09.025

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

昆明医科大学第二附属医院消化内科，昆明 650101

基金项目:

国家自然科学基金 (82160106)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：张兴会负责查阅文献、资料分析、图表制作、撰写论文；郑梦瑶参与修改论文；杨晋辉指导撰写文章并最后定稿。

详细信息

通信作者:
杨晋辉， yangjinhuikyfey@163.com （ORCID： 0000－0002－4240－4025）

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出版历程
- 收稿日期: 2022-12-11
- 录用日期: 2023-01-16
- 出版日期: 2023-09-19

Research progress of sarcopenia in patients with liver cirrhosis

Department of Gastroenterology，The 2nd Affiliated Hospital of Kunming Medical University，Kunming 650101，China

Research funding:

National Natural Science Foundation of China (82160106)

More Information

Corresponding author: YANG Jinhui， yangjinhuikyfey@163.com （ORCID： 0000－0002－4240－4025）

摘要

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。
- 肝硬化 /
- 肌减少症 /
- 诊断
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.
- Liver Cirrhosis /
- Sarcopenia /
- Diagnosis

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图 1 肌少症在肝硬化患者中的发生机制

Figure 1. Mechanisms of sarcopenia in patients with liver cirrhosis

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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

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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）
检测内容	检测工具	男	女	男	女
肌量测定	CT	<36.5 cm²/m^2［3］	<30.2 cm²/m^2［3］	<52.4 cm²/m^2［4］	<38.5 cm²/m^2［4］
	BIA	<7.0 kg/m^2［5］	<5.7 kg/m^2［5］	<7.0 kg/m^2［6］	<5.5 kg/m^2［6］
	DEXA	<7.0 kg/m^2［5］	<5.4 kg/m^2［5］	<7.0 kg/m^2［6］	<5.5 kg/m^2［6］
肌力测定	握力器	<28 kg^［5］	<18 kg^［5］	<27 kg^［6］	<16 kg^［6］
肌力测定	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］
身体活动功能	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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