中西医结合肝病杂志2025，Vol.35Issue(5)：554-559,6.DOI:10.3969/j.issn.1005-0264.2025.005.005
失代偿期肝硬化患者TPTI及L3-SMI与营养风险的相关性分析及L3-SMI在肝硬化并肌肉减少症患者中的临床应用价值
Correlation analysis of TPTI and L3-SMI with nutritional risk in patients with decompensated cirrhosis and Clinical value of L3-SMI in patients with cirrhosis and sarcopenia
摘要
Abstract
Objective:To investigate the association between TPTI(transversal psoas thickness index),L3-SMI(the third lumbar spine skeletal muscle index),and nutritional risk in patients with decompensated cirrhosis and to explore the clinical value of L3-SMI in patients with cirrhosis combined with sarcopenia.Methods:A retrospective cohort study was conducted by recruiting patients who were diagnosed with decompensated cirrhosis at Wuhan No.1 Hospital with intact abdominal computed tomography imaging from June 1st,2019 to December 31st,2023.Physiological and biochemical index,triceps skinfold thickness(TSF),upper arm circumference(AC),and upper arm muscle circumference(AMC)will be collected from eligible subjects.TPTI and L3-SMI would be calculated based on the transverse diameter of the right psoas muscle(TDPM)and the total cross-sectional area of the skeletal muscle(SMA)at the level of the third lumber vertebra in imaging analysis software,respectively.Follow-up was done for 1 year to observe the occurrence of complications during the treatment period.Those whose score a greater than or equal to 1 in the royal free hospital-nutritional prioritizing tool(RFH-NPT)would be regarded as nutritional risk.T-test and Fisher exact test would be performed to analyze whether risk factors were significantly different from groups with and without nutritional risk,and univariate logistic regression would be performed to further explore the association between risk factors and the occurrence of nutritional risk.AP＜0.05 was considered statistically significant.Results:A total of 122 patients was enrolled in the study,among whom 52.46％were male and the majority were infected by the Hepatitis B-virus.About 93.44％of patients had malnutrition,in which group the average age was significantly larger than those without malnutrition(P=0.004),whereas the level of BMI,TSF,and AMC were lower(P=0.009,0.002,0.003,respectively).Moreover,the levels of TPTI and L3-SMI were significantly lower in the group with nutritional risk compared to those without nutritional risk(P=0.008,0.042,respectively).However,there was no significant difference between groups with and without nutritional risk in terms of etiology of decompensated cirrhosis,Child-pugh class,Alb,and PT.Furthermore,univariate logistic regression revealed that the likelihood of malnutrition occurrence was negatively associated with BMI,TSF,AMC,TPTI,and L3-SMI,indicating the relative risk of TPTI and L3-SMI were 0.575 and 0.891,respectively(P＜0.05).In this study,the mean L3-SMI was 41.39±6.01 cm2/m2 in male patients and 35.16±5.53 cm2/m2 in females,with a significant difference between the two values(P=0.000 1).The ratio of patients in the reduced muscle mass group to those in the normal muscle mass group was 56∶66,with a higher proportion of males in the reduced muscle mass group(32.79％)and females in the normal muscle mass group(34.43％),and the difference in gender distribution between the two groups was statistically significant(P＜0.05).Child B and C grades were higher in the reduced muscle mass group(21.31％and 14.75％,respectively),and Child A and B grades were higher in the normal muscle mass group(27.87％and 21.31％,respectively),and the difference in the distribution of Child-Pugh grades between the two groups was statistically significant(P＜0.05).ALB in the reduced muscle mass group was lower than that in the normal muscle mass group,and PT and TLC were higher than that in the normal muscle mass group,and the difference was not statistically significant(P＞0.05).L3-SMI,BMI,TSF,AMC were significantly lower in the sarcopenia group than in the normal muscle mass group,and the difference was statistically significant(P＜0.05),and TPTI was lower in the sarcopenia group than in the normal muscle mass group,but the difference was not statistically significant(P＞0.05).At one-year follow-up,the probability of complications was significantly higher in the patients in the reduced muscle mass group than in the patients in the normal muscle mass group(33.93％vs 16.67％,P＜0.05).Conclusion:For patients with decompensated cirrhosis,TPTI,and L3-SMI were significantly associated with the occurrence of malnutrition,to be a specific,lower level of TPTI and L3-SMI,higher risk of malnutrition.The incidence of sarcopenia increased with increasing Child-Pugh classification.Patients with decompensated cirrhosis with combined sarcopenia had a higher complication rate than patients with normal muscle mass.关键词
肝硬化/营养风险/TPTI/L3-SMIKey words
liver cirrhosis/nutritional risk/transversal psoas thickness index/the third lumbar spine skeletal muscle index分类
医药卫生引用本文复制引用
陈露,李瀚旻..失代偿期肝硬化患者TPTI及L3-SMI与营养风险的相关性分析及L3-SMI在肝硬化并肌肉减少症患者中的临床应用价值[J].中西医结合肝病杂志,2025,35(5):554-559,6.基金项目
国家自然科学基金项目(No.81373513),武汉市卫健委中医药科研项目(No.WZ22Q30) （No.81373513）
