非酒精性脂肪性肝病患者骨骼肌质量变化研究*

doi:10.3969/j.issn.1672-5069.2023.05.011

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病 (NAFLD)患者骨骼肌质量(SMM)变化。方法 2020年1月～2021年6月南京医科大学第一附属医院健康管理中心体检者7467例, 根据腹部超声检查结果发现NAFLD患者3385例,另4082例无NAFLD人群为对照。采用NAFLD肝纤维化评分(NFS)＞0.676诊断进展性肝纤维化者39例,无肝纤维化者2591例,非进展性肝纤维化者755例。计算SMM指数(SMI)=四肢骨骼肌质量(ASM)/体质量(BW)。结果 NAFLD患者SMI显著低于对照组【(38.8±3.3)% 对(40.7±3.3)%, P<0.01】;Logistic回归分析显示,校正一些代谢因素后,SMI (OR=0.719,95%CI 0.694～0.745,P<0.001)仍然是NAFLD发生的独立影响因素;在总人群中,以有无NAFLD为因变量,以SMI三分位数为自变量,以SMI高水平为参照,结果提示,校正一些危险因素,如年龄、血糖和血脂后,SMI低水平组和SMI中水平组患NAFLD的风险分别增加了1.482倍和2.328倍,低、中和高SMI组NAFLD发生率分别为53.5%、46.8%和35.8%(P<0.05);进展性肝纤维化组SMI为(37.6±3.6)%,显著低于非进展性肝纤维化组或无肝纤维化组【分别为【(38.1±3.5)% 或(39.0±3.2)%, P<0.01】;在3385例NAFLD患者中,将SMI三分位,即SMI低水平1129例、中水平1128例和高水平1128例,结果提示,低、中和高SMI组进展性肝纤维化发生率分别为1.9%、1.0%和0.6%(P<0.05),无进展性肝纤维化发生率分别为26.6%、22.2%和18.0%(P<0.05),无肝纤维化发生率分别为71.5%、76.8%和81.4%(P<0.05)。结论 NAFLD患者SMM可能减少,并与进展性肝纤维化密切相关,需要高度关注。

关键词: 非酒精性脂肪性肝病, 骨骼肌质量, 进展性肝纤维化

Abstract: Objective The aim of this study was to investigate the skeletal muscle mass (SMM) changes in patients with non-alcoholic fatty liver diseases (NAFLD). Methods A total of 7467 individuals were encountered in the Health Management Center, First Affiliated Hospital, Nanjing Medical University between January 2020 and June 2021, and the physical examination were carried out. The abdominal ultrasonography showed the NAFLD in 3385 cases and other 4082 persons served as the control. The NAFLD fibrosis score (NFS) greater than 0.676 was found in 39 cases with advanced liver fibrosis (ALF), in 2591 cases without liver fibrosis and in 755 cases with non-advanced liver fibrosis. The SMM index (SMI) was calculated as follows: the appendicular skeletal muscle mass/ body weight. Results The SMI in patients with NAFLD was (38.8±3.3)%, significantly lower than [(40.7±3.3)%, P<0.01] in the control; the Logistic regression analysis showed that the SMI was the independent impacting factor for NAFLD occurrence as corrected by metabolic factors (OR=0.719, 95%CI 0.694-0.745, P<0.001); the 7467 individuals were divided into three groups by SMI tertiary, the analysis showed corrected by age, blood sugar and fat that individuals with low and middle SMI had 1.482 times and 2.328 times high tendency of risk for NAFLD compared to those with high SMI as the reference, and the incidences of NAFLD in individuals with low, middle and high SMI were 53.5%, 46.8% and 35.8%(P<0.05); the SMI in patients with ALF was (37.6±3.6)%, significantly lower than in with non-advanced or without liver fibrosis [(38.1±3.5)% or (39.0±3.2)%, P<0.01]; the patients with NAFLD were divided into three groups by SMI tertiary as with low SMI in 1129 cases, middle in 1128 cases and high in 1128 cases, and the analysis showed that the incidences of ALF in patients with low, middle and high SMI were 1.9%, 1.0% and 0.6%(P<0.05), of without ALF were 26.6%, 22.2% and 18.0%(P<0.05), and of without liver fibrosis were 71.5%, 76.8% and 81.4%(P<0.05). Conclusion The decreased SMM is common in patients with NAFLD and might be related to ALF, which needs further investigation.

Key words: Non-alcoholic fatty liver diseases, Skeletal muscle mass, Advanced liver fibrosis

吴非, 郭雯, 张群. 非酒精性脂肪性肝病患者骨骼肌质量变化研究^*[J]. 实用肝脏病杂志, 2023, 26(5): 646-649.

Wu Fei, Guo Wen, Zhang Qun. Skeletal muscle mass changes in patients with non-alcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2023, 26(5): 646-649.

参考文献

[1] 杨蕊旭,范建高. 非酒精性脂肪性肝病相关肝细胞癌流行病学与筛查. 实用肝脏病杂志2022, 25(2): 153-156.
[2] Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease. Lancet, 2021, 397(10290):2212-2224.
[3] Targher G, Tilg H, Byrne CD. Non-alcoholic fatty liver disease: a multisystem disease requiring a multidisciplinary and holistic approach. Lancet Gastroenterol Hepatol, 2021, 6(7):578-588.
[4] Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev,2013,93(3):993-1017.
[5] Al-Ozairi E, Alsaeed D, Alroudhan D, et al. Skeletal muscle and metabolic health: how do we increase muscle mass and function in people with type 2 diabetes? J Clin Endocrinol Metab, 2021,106(2):309-317.
[6] Nomura K, Eto M, Ogawa S, et al. Association between low muscle mass and metabolic syndrome in elderly Japanese women. PLoS One, 2020,15(12): e0243242.
[7] Lee MJ, Kim EH, Bae SJ, et al. Age-related decrease in skeletal muscle mass is an independent risk factor for incident nonalcoholic fatty liver disease: A 10-year retrospective cohort study. Gut Liver,2019,13(1):67-76.
[8] Kim G, Lee SE, Lee YB, et al. Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: A 7-year longitudinal study. Hepatology, 2018,68(5):1755-1768.
[9] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪肝专家委员会.非酒精性脂肪性肝病防治指南 (2018年版).实用肝脏病杂志,2018,21(2):177-186.
[10] Chun HS, Lee M, Lee HA, et al. Association of physical activity with risk of liver fibrosis, sarcopenia, and cardiovascular disease in nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol, 2022, S1542-3565(22)00001-5.
[11] 杨燕,姚艺璇,洪秀韬,等.应用胰岛素抵抗替代指标评估2型糖尿病患者非酒精性脂肪肝及进展性肝纤维化的价值. 中华内分泌代谢杂志,2021,37(4):281-287.
[12] Chakravarthy MV, Siddiqui MS, Forsgren MF, et al. Harnessing muscle-liver crosstalk to treat nonalcoholic steatohepatitis. Front Endocrinol (Lausanne), 2020,11:592373.
[13] Kim D, Wijarnpreecha K, Sandhu KK, et al. Sarcopenia in nonalcoholic fatty liver disease and all-cause and cause-specific mortality in the United States. Liver Int, 2021,41(8):1832-1840.
[14] Ooi PH, Hager A, Mazurak VC, et al. Sarcopenia in chronic liver disease: impact on outcomes. Liver Transpl, 2019, 25(9):1422-1438.
[15] Koo BK, Kim D, Joo SK, et al. Low skeletal muscle mass is associated with non-alcoholic fatty liver disease in Korean adults: the Fifth Korea National Health and Nutrition Examination Survey. Hepatobiliary Pancreat Dis Int, 2016, 15(1):39-47.
[16] Koo BK, Kim D, Joo SK, et al. Sarcopenia is an independent risk factor for non-alcoholic steatohepatitis and significant fibrosis. J Hepatol, 2017, 66(1):123-131.
[17] Gan D, Wang L, Jia M, et al. Low muscle mass and low muscle strength associate with nonalcoholic fatty liver disease. Clin Nutr, 2020,39(4):1124-1130.
[18] Bhanji RA, Narayanan P, Allen AM, et al. Sarcopenia in hiding: the risk and consequence of underestimating muscle dysfunction in nonalcoholic steatohepatitis. Hepatology, 2017,66(6):2055-2065.
[19] Kim JA, Choi KM. Sarcopenia and fatty liver disease. Hepatol Int, 2019, 13 (6): 674-687.
[20] Cai C, Song X, Chen Y, et al. Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: a systematic review and meta-analysis. Hepatol Int,2020,14(1):115-126.
[21] Hsieh YC, Joo SK, Koo BK, et al. Muscle alterations are independently associated with significant fibrosis in patients with nonalcoholic fatty liver disease. Liver Int, 2021,41(3):494-504.

非酒精性脂肪性肝病患者骨骼肌质量变化研究^*

Skeletal muscle mass changes in patients with non-alcoholic fatty liver diseases

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