用超声波测量评估肝硬化患者的肌肉疏松症及其与临床结果的相关性

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.010
P. Gallo , V. Flagiello , A. De Vincentis , F. Terracciani , A. Falcomata , A. Picardi , U. Vespasiani Gentilucci
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引用次数: 0

摘要

引言 肌肉疏松症是肝硬化患者常见的并发症。在这种情况下,其诊断通常基于操作定义,包括对低肌肉质量的估计。最近,基于肌肉超声的测量方法因其更高的可行性和可及性而备受关注。然而,对这种方法进行评估的研究报告数量有限。在一组肝硬化患者中,我们的主要目的是研究超声测量的肌肉质量与作为金标准的生物阻抗分析(BIA)之间的相关性和一致性,以及它们的鉴别力。此外,作为次要目标,我们还研究了这些技术和肌肉力量与临床结果之间的相关性。材料和方法该研究包括连续就诊于罗马 Fondazione Policlinico Campus Bio-Medico 肝病科的成年门诊患者。根据塞尔吉方程(EWGSOP 2019),肌肉质量被定义为阑尾骨骼质量(ASMM)。根据之前描述的标准化指数(股四头肌和髂腰肌)进行超声波测量肌肉质量。手部握力测量用于定义肌肉力量。皮尔逊相关系数和布兰德-阿尔特曼图用于评估 ASMM 与超声指数之间的相关性和一致性。通过计算接收者操作特征曲线下面积(AUROC)来估计预测性能。最后,进行了粗略和调整后的 Cox 回归分析,以检验不同的肌肉疏松代用指标与肝脏失代偿或 24 个月内死亡率之间可能存在的关联。肝硬化最常见的病因是病毒(40%),大多数患者(80%)的肝功能保存良好。平均压缩指数(ACI)和平均羽毛指数(AFI)与 ASMM 有很好的相关性,而在腰肌指数中,只有腰肌身高比(PHR)与回肠腰肌指数(IPI)有相关性(图 1)。线性回归分析证实,AFI [beta 0.64 (CI95% 0.37-0.92),p<0.001]、ACI [0.5 (CI95% 0.21-0.78),p<0.001] 和 PHR [0.38 (CI95% 0.08-0.69),p=0.01] 与 ASMM 显著相关,且与性别无关。此外,Bland-Altman 分析表明 US 与 ASMM 的一致性良好。此外,这些指数显示出足够的鉴别力,ACI、AFI 和 PHR 的 AUROC 分别为 0.71(0.57-0.854)、0.81(0.69-0.931)和 0.75(0.63-0.862)。最后,在 Cox 回归分析中,只有低肌力与较高的死亡率和肝脏失代偿率相关[HR 1.62(1.06-2.47),P 0.026;HR 1.29(0.99-1.69),P 0.064]。同时,在我们的研究对象中,只有低肌力对预后有重要的预测作用。如果这些结果能在更大规模的外部系列研究中得到证实,那么超声波就可以作为一种可行且具有成本效益的工具,用于评估肝硬化患者的肌肉质量,而动态肌力减低症则应该用于更好地识别预后最差的患者。
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Assessment of sarcopenia with ultrasound-based measurements in patients with liver cirrhosis and correlation with clinical outcomes

Introduction

Sarcopenia is a common complication in patients with liver cirrhosis. In this context, its diagnosis is typically based on operational definitions, including the estimation of low muscle mass. Recently, muscle ultrasound-based measurements have drawn attention due to their improved feasibility and accessibility. However, only a limited number of studies evaluating this approach have been reported. Finally, the role of muscle strength respect to mass in identifying patients with the worst clinical outcomes has not been clearly elucidated.

Aim

In a cohort of cirrhotic patients, our primary aim was to investigate the correlation and agreement between ultrasound-derived measures of muscle mass and bioimpedance analysis (BIA) as the gold standard, as well as their discriminative power. In addition, as a secondary aim, we investigated the correlation of these techniques and muscle strength with clinical outcomes.

Materials and Methods

The study included consecutive adult outpatients attending the Hepatology Unit of the Fondazione Policlinico Campus Bio-Medico of Rome. Muscle mass was defined as appendicular skeletal mass (ASMM) according to the Sergi equation (EWGSOP 2019). Ultrasound was performed to measure muscle mass according to previously described standardized indices (quadriceps and iliopsoas muscles). Hand grip measurement was used to define muscle strength. Pearson's correlation coefficient and Bland-Altman plots were used to assess the correlation and agreement between ASMM and ultrasound indices. Predictive performance was estimated by calculating the area under the receiver operating characteristic curve (AUROC). Finally, crude and adjusted Cox regression analyses were performed to test the possible association between the different proxies of sarcopenia and liver decompensation or mortality within 24 months.

Results

88 patients were included [(mean age 73 years (7.07), 78% male, mean BMI 27 kg/m2 (10)]. The most common aetiology of cirrhosis was viral (40%) and the majority of patients (80%) had well preserved liver function. Average compression index (ACI) and average feather index (AFI) showed a good correlation with ASMM, while among the psoas indices, only psoas to height ratio (PHR)- but not ileopsoas index (IPI) - showed a correlation (Figure 1). Linear regression analysis confirmed that AFI [beta 0.64 (CI95% 0.37-0.92), p<0.001], ACI [0.5 (CI95% 0.21-0.78), p<0.001] and PHR [0.38 (CI95% 0.08-0.69), p=0.01] were significantly associated with ASMM, also independently of gender. In addition, Bland-Altman analyses showed good agreement for US with ASMM. Furthermore, these indices showed adequate discriminatory power, with AUROCs of 0.71 (0.57-0.854), 0.81 (0.69-0.931) and 0.75 (0.63-0.862) for ACI, AFI and PHR, respectively. Finally, in Cox regression analyses, only low muscle strength was associated with higher rates of mortality and liver decompensation [HR 1.62(1.06-2.47), p 0.026; HR 1.29(0.99-1.69), p 0.064].

Conclusions

Ultrasound measurements of quadriceps and psoas diameters showed good correlation and agreement with muscle mass defined by BIA in cirrhotic patients, displaying also an adequate discriminatory ability. At the same time, only low muscle strength exhibited a valuable predictive role for outcomes in our population. If these results are confirmed in larger external series, ultrasound can be proposed as a feasible and cost-effective tool for the assessment of muscle mass in patients with CLD, while dynopenia should be used to better identify patients with the worst outcomes.

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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
期刊介绍: Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.
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