Sarcopenia is associated with the risk of significant liver fibrosis in metabolically unhealthy subjects with chronic hepatitis B
Sarcopenia is associated with the risk of significant liver fibrosis in metabolically unhealthy subjects with chronic hepatitis B
复制标题
DOI：
10.1111/apt.14843
复制
发表时间：
2018-08-01
影响因子：
7.6
通讯作者：
Kim, S. U.
中科院分区：
文献类型：
--
作者：
Han, E.;Lee, Y. -H.;Kim, S. U.
背景：肌少症与肝纤维化程度显著相关。本研究调查了慢性乙型肝炎患者肌肉减少症对肝纤维化的影响。方法：分析2008-2011年韩国国家健康与营养检查调查的数据。采用双能x线吸收仪计算骨骼肌减少指数（总阑尾骨骼肌质量[kg]/体重指数[kg/m(2)]）。肌少症被定义为最低的五分位数肌少症指数值（临界值：男性0.89，女性0.58）。使用非酒精性脂肪性肝病纤维化评分和纤维化-4指数评估纤维化负担。显著纤维化定义为非酒精性脂肪性肝病纤维化评分最高的四分位数，纤维化-4指数>= 2.67。结果：在506名慢性乙型肝炎患者（258名男性和248名女性）中，非酒精性脂肪性肝病纤维化评分和纤维化-4指数分别鉴定出126例（24.9%）和217例（42.9%）的肌肉减少症和显著纤维化。无论采用何种纤维化预测模型，肌少症均与显著纤维化显著相关（均P < 0.05）。根据代谢因素对研究人群进行分层时，在肥胖、胰岛素抵抗、代谢综合征和肝脂肪变性亚组中，肌肉减少症与显著纤维化风险增加特别相关（优势比2.37-3.57，均P < 0.05）。校正其他混杂因素后，发现肌肉减少症与显著纤维化之间存在独立关联（非酒精性脂肪性肝病纤维化评分的比值比为2.67-3.62，纤维化-4指数的比值比为2.04-2.62，均P < 0.05）。结论：慢性乙型肝炎患者肌肉减少症与显著纤维化相关，特别是肥胖、胰岛素抵抗、代谢综合征和肝脂肪变性患者。
Background: Sarcopenia is significantly associated with the degree of liver fibrosis. This study investigated the influence of sarcopenia on liver fibrosis in individuals with chronic hepatitis B.Methods: Data from the Korean National Health and Nutrition Examination Surveys 2008-2011 were analysed. The sarcopenia index (total appendicular skeletal muscle mass [kg]/body mass index [kg/m(2)]) was calculated using dual-energy X-ray absorptiometry. Sarcopenia was defined as the lowest quintile sarcopenia index value (cutoffs: 0.89 for men and 0.58 for women). The fibrotic burden was assessed using the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index. Significant fibrosis was defined as the highest nonalcoholic fatty liver disease fibrosis score quartile and a fibrosis-4 index >= 2.67.Results: Among the 506 respondents with chronic hepatitis B (258 men and 248 women), the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index identified sarcopenia and significant fibrosis in 126 (24.9%) and 217 (42.9%), respectively. Sarcopenia was significantly associated with significant fibrosis, regardless of the fibrosis prediction model used (all P < 0.05). When the study population was stratified according to metabolic factors, sarcopenia was specifically associated with an increased risk of significant fibrosis among subgroups with obesity, insulin resistance, metabolic syndrome and liver steatosis (odds ratio 2.37-3.57; all P < 0.05). An independent association between sarcopenia and significant fibrosis was identified after adjusting for other confounders (odds ratio 2.67-3.62 by the nonalcoholic fatty liver disease fibrosis score and 2.04-2.62 by the fibrosis-4 index; all P < 0.05).Conclusions: Sarcopenia is associated with significant fibrosis in subjects with chronic hepatitis B, specifically those with obesity, insulin resistance, metabolic syndrome and liver steatosis.