Editorial: sarcopenia in liver transplantation-our weakest patients may need the strongest push.
Editorial: sarcopenia in liver transplantation-our weakest patients may need the strongest push.
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社论：肝移植中的肌少症——我们最虚弱的患者可能需要最强的推动。
DOI：
10.1111/apt.15204
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发表时间：
2019
影响因子：
7.6
通讯作者：
Rinella,Mary
中科院分区：
文献类型：
--
作者：
Mazumder,Nikhilesh;Rinella,Mary
肌肉减少症在近60年前被确定为晚期肝硬化的常见表现。虽然晚期肝病的风险预测一直集中在实验室得出的标准，如MELD评分，但由于其与独立于MELD的不良结局的相关性，肌肉减少症最近引起了关注1。Bhanji等人报告了一项回顾性研究的结果，该研究涉及2002年至2006年期间接受肝移植的293名成人2。他们使用常规临床护理期间进行的CT扫描表征了身体组成，并报告了骨骼肌指数（SMI）的进行性降低，同时伴有肌脂肪变性的增加，这两种情况均导致移植，术后继续进行。移植后一年，只有5名患者解决了移植前的肌肉减少症，另有25名患者发生了肌肉减少症。一个局限性（并非本研究独有）是从非方案驱动的成像中采集肌肉减少症测量值，导致随访成像缺失率较高。以这种方式外推的数据也可能受到选择偏倚的严重影响，因为接受成像的患者通常对并发症有一些担忧，或者正在监测癌症，这两者都与肌肉减少症有关3。虽然受其回顾性的限制，这项研究拓宽了我们对移植后肌减少症的时间进程及其恢复或缺乏恢复的理解。
Sarcopenia was identified nearly 60 years ago as a common manifestation of advanced cirrhosis. Although risk prediction in advanced liver disease has been focused on laboratoryderived criteria such as the MELD score, sarcopenia has garnered recent attention due to its association with adverse outcomes independent of MELD1.Bhanji et al reported the findings of a retrospective study of 293 adults who underwent liver transplantation between 2002 and 20062. They characterized body composition using CT scans performed during routine clinical care and reported a progressive decrease in skeletal muscle index (SMI) with a concomitant increase in myosteatosis both leading up to transplantation with continuation post-operatively. After a year post transplant, only five patients resolved their pre-transplant sarcopenia and an additional 25 developed sarcopenia de novo. A limitation (not unique to this study) is the acquisition of sarcopenia measures from non-protocol-driven imaging resulting in high rates of missing follow-up imaging. Data extrapolated in this manner can also be heavily influenced by selection bias as patients who undergo imaging usually have some concern for complication or are being monitored for cancer, both of which are associated with sarcopenia3. While limited by its retrospective nature, this study broadens our understanding of the time course of sarcopenia posttransplant and its recovery—or lack thereof.