Myosteatosis, but not Sarcopenia, Predisposes NAFLD Subjects to Early Steatohepatitis and Fibrosis Progression
Myosteatosis, but not Sarcopenia, Predisposes NAFLD Subjects to Early Steatohepatitis and Fibrosis Progression
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DOI：
10.1016/j.cgh.2022.01.020
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发表时间：
2023-01-23
影响因子：
12.6
通讯作者：
Kim, Won
中科院分区：
文献类型：
--
作者：
Hsieh, Yun-Cheng;Joo, Sae Kyung;Kim, Won
背景目的：肌肉减少症和肌骨化症与晚期非酒精性脂肪性肝病（NAFLD）相关。然而，早期NAFLD的肌肉改变仍不清楚。方法：从前瞻性活检证实的NAFLD队列中选择无显著纤维化的非酒精性脂肪肝（NAFL）或早期非酒精性脂肪性肝炎（NASH）患者（N[338]）。骨骼肌指数和平均肌肉衰减（MA）测量使用腹部脂肪计算机断层扫描在第三腰椎水平。严重骨骼肌病被定义为性别分层MA值的最低四分位数。结果：早期NASH患者（n = 87）的MA （45.61 & PLUSMN; 6.45 vs 47.48 +/- 5.85 HU; P = 0.028）低于NAFL患者（n = 251），但骨骼肌指数相似。小叶炎症和肝细胞水肿越严重，MA越低（P = 0.003和P = 0.041）。早期NASH患者的严重骨骼肌病患病率高于NAFL患者（33.3% vs 21.1%; P = 0.029）。在多变量分析中，经年龄、性别和代谢因素校正（优势比，2.45；95%可信区间（CI）， 1.24-4.86）后，严重肌骨疏松症患者更有可能发生早期NASH，在调整内脏脂肪量（优势比，2.44;95% CI, 1.22-4.89）后，这种情况仍然存在。在中位29个月的随访中，170名患者接受了反复的瞬时弹性成像。纤维化进展-肝硬度测量>= 2 kPa或第二肝硬度测量>= 7 kPa-分别在28和31个人中发现。调整各种混杂因素后，严重肌骨增生与纤维化进展显著相关（不同纤维化进展定义的风险比为2.49,95% CI为1.15-5.40，风险比为2.09,95% CI为1.01-4.34）。结论：严重的肌骨化病与早期NASH和早期NAFLD的纤维化进展显著相关。
BACKGROUND AIMS: Sarcopenia and myosteatosis are associated with advanced nonalcoholic fatty liver disease (NAFLD). However, muscle alterations in early stage NAFLD remain unclear.METHODS: Patients with nonalcoholic fatty liver (NAFL) or early nonalcoholic steatohepatitis (NASH) without significant fibrosis were selected from a prospective biopsy-proven NAFLD cohort (N [ 338). The skeletal muscle index and mean muscle attenuation (MA) were measured using abdominal fat computed tomography at the third lumbar vertebra level. Severe myosteatosis was defined as the lowest quartile of sex-stratified MA values.RESULTS: Patients with early NASH (n = 87) had lower MA (45.61 & PLUSMN; 6.45 vs 47.48 +/- 5.85 HU; P = .028) than patients with NAFL (n = 251) but a similar skeletal muscle index. Patients with more severe lobular inflammation and hepatocellular ballooning had lower MA (P = .003 and P = .041, respectively). The severe myosteatosis prevalence was higher in early NASH than in NAFL (33.3% vs 21.1%; P = .029). Patients with severe myosteatosis were more likely to have early NASH in multivariable analysis adjusted for age, sex, and metabolic factors (odds ratio, 2.45; 95% confidence interval (CI), 1.24-4.86), which was maintained after adjustment for visceral fat amount (odds ratio, 2.44; 95% CI, 1.22-4.89). During a median 29-month follow-up, 170 patients underwent repeated transient elastography. Fibrosis progression-an increase in liver stiffness measurement >2 kPa or second liver stiffness measurement >= 7 kPa-was found in 28 and 31 individuals. Severe myosteatosis was significantly associated with fibrosis progression after adjustment for various confounders (hazard ratio, 2.49; 95% CI, 1.15-5.40 and hazard ratio, 2.09; 95% CI, 1.01-4.34 for different fibrosis progression definitions).CONCLUSIONS: Severe myosteatosis is significantly associated with early NASH and fibrosis progression in early stage NAFLD.