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*

doi:10.3969/j.issn.1672-5069.2020.04.004

摘要/Abstract

摘要： 目的观察慢加急性肝衰竭(ACLF)患者第三腰椎骨骼肌指数(L3-SMI)及其与临床指标的关系。方法 2015年1月～2019年6月我院收治的126例住院期间完善了腹部CT或MRI检查的ACLF患者,计算L3-SMI,比较不同L3-SMI水平患者的临床特点。结果入组患者男性113例,女性13例;男性患者L3-SMI为(40.3±7.4)cm²/m²,显著大于女性患者[(33.9±4.5)cm²/m²,P＜0.05];在男性患者中,有肝硬化基础者L3-SMI为(38.1±5.9)cm²/m²,显著低于无肝硬化基础者[(42.0±7.9)cm²/m², P＜0.05];酒精性肝病患者L3-SMI为(34.8±6.8)cm²/m²,显著低于非酒精性肝病患者[(41.5±7.0)cm²/m², P＜0.05];90 d生存组患者L3-SMI为(40.7±7.7)cm²/m²,与90 d死亡患者[(38.8±6.3)cm²/m², P＞0.05]比,差异无统计学意义;将男性患者分为低L3-SMI组(≤40 cm²/m²)61例和高L3-SMI组(＞40 cm²/m²)52例,结果低L3-SMI组和高L3-SMI组患者肝性脑病发生率分别为19.7%和13.5% (P＞0.05),低L3-SMI组90 d生存率为68.9%,与高L3-SMI组的76.9%(P＞0.05)比,差异无统计学意义;高L3-SMI组患者体质指数为(24.5±3.9)kg/m²,显著高于低L3-SMI组[(20.5±2.9)cm²/m², P＜0.05];高L3-SMI组患者血红蛋白为(126.4±23.2)g/L,显著高于低L3-SMI组[(114.7±21.3)g/L, P＜0.05];高L3-SMI组患者血钠为(136.6±4.1)g/L,显著高于低L3-SMI组[(133.5±4.5)g/L, P＜0.05];低L3-SMI组和高L3-SMI组患者血清总胆红素分别为[(437.1±198.3)μmol/L和(317.4±173.0)μmol/L,P＜0.05],差异显著。结论女性患者、低体质量患者、肝硬化患者、酒精性肝病患者L3-SMI水平更低,ACLF患者L3-SMI水平与病情严重程度呈负相关,与疾病转归存在一定的相关性,但需进一步扩大样本进行验证。

关键词: 慢加急性肝衰竭, 临床特点, 骨骼肌指数

Abstract: Objective To investigate the relationship between skeletal muscle index of the third lumbar vertebrae (L3-SMI) and clinical indexes in patients with acute on chronic liver failure (ACLF). Methods 126 patients with ACLF were admitted to our hospital From January 2015 to June 2019,and underwent abdominal CT or MRI scan. L3-SMI was calculated and the clinical characteristics of patients with different SMI levels were compared. Results In this study, 113 male patients and 13 female patients were included; the L3-SMI of male patients was (40.3±7.4) cm²/m², significantly higher than that of female patients [(33.9±4.5) cm²/m², P< 0.05]; the L3-SMI of male patients with liver cirrhosis was (38.1 ±5.9)cm²/m², which was significantly lower than that of non-liver cirrhosis patients [(42.0±7.9)cm²/m², P＜0.05]; the L3-SMI of patients with alcoholic liver disease was (34.8±6.8)cm²/m², which was significantly lower than that of patients with non-alcoholic liver disease [(41.5±7.0)cm²/m², P＜0.05]; the L3-SMI in 90-day survival was (40.7±7.7) cm²/m², not significantly different compared to [(38.8±6.3) cm²/m², P > 0.05]in dead patients; according to the median L3-SMI, the male patients were divided into low L3-SMI group (n = 61) and high L3-SMI group (n = 52); the percentages of hepatic encephalopathy in low L3-SMI group and high L3-SMI group were 19.7% and 13.5%, respectively (P > 0.05), the 90-day survival rate in low L3-SMI group was 68.9%, not significantly different compared to 76.9% in high L3-SMI group (P> 0.05), while the BMI of high L3-SMI group was (24.5±3.9) kg/m², significantly higher than that of low L3-SMI group [(20.5±2.9) cm²/m², P < 0.05]; the blood hemoglobin level in patiets with high L3-SMI group was (126.4±23.2) mmol/L, significantly higher than that in low L3-SMI group [(114.7±21.3) mmol/L, P < 0.05]; serum sodium in patients high L3-SMI group was (136.6±4.1)g/L, significantly higher than that in low L3-SMI group[(133.5±4.5)g/L, P <0.05]; serum total bilirubin level in patients with low L3-SMI group and high L3-SMI group were [(437.1±198.3)μmol/L and (317.4±173.0)μmol/L, respectively, P < 0.05]. Conclusion The level of L3-SMI in female patients, low weight patients, patients with liver cirrhosis and patients with alcoholic liver disease is lower. The level of L3-SMI in patients with ACLF is negatively correlated with the severity of the disease and has a certain correlation with the outcome of the patients, but the samples need to be further expanded to verify the correlation.

Key words: Acute-on-chronic liver failure, Clinical characteristics, Skeletal muscle index

李侗曾, 孔明, 宋文艳, 徐曼曼, 陈煜, 全国疑难及重症肝病攻关协作组. 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.

Li Tongzeng, Kong Ming, Song Wenyan, et al. Relationship between skeletal muscle index of third lumbar vertebrae and clinical characteristics in patients with acute on chronic liver failure[J]. Journal of Practical Hepatology, 2020, 23(4): 467-470.

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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^*

Relationship between skeletal muscle index of third lumbar vertebrae and clinical characteristics in patients with acute on chronic liver failure

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