Visceral adiposity in cirrhosis: Association with disease severity and impact of liver transplantation.
Visceral adiposity in cirrhosis: Association with disease severity and impact of liver transplantation.
复制标题
DOI：
10.1097/hc9.0000000000000113
复制
发表时间：
2023-06-01
影响因子：
5.1
通讯作者：
中科院分区：
文献类型：
--
作者：
肝硬化患者脂肪组织分布的变化特征不明确，可能影响临床结果。回顾性评估2008年1月至2017年8月成人肝移植（LT）术前6个月内的腹部MRI。在L3处测定内脏脂肪组织、皮下脂肪组织和骨骼肌面积（cm2）。用内脏与皮下脂肪组织比（VSR）来定义脂肪的相对分布，并按性别分层。用Pearson检验相关性。通过child - turcote - pugh （CTP）分级比较肝移植前后的体成分测量，并评估其作为临床结果的预测因子。共研究了318例患者。平均年龄56岁，女性33.64%，CTP - C肝硬化47.80%。与CTP a相比，CTP C与VSR增加0.42点相关（95% CI = 0.13-0.71, p < 0.01），校正了年龄、性别、糖尿病和HCC。在79例（24.84%）术后1-2年复查MRI的患者中，VSR较术前显著改善（1.31 vs. 0.95, p < 0.01）。在校正分析中，与lt前VSR相比，CTP C与lt后VSR下降0.86点相关（95% CI = - 1.27 ~ - 0.44, p < 0.01）。体重指数与lt前后的VSR相关性较差。lt前VSR升高与lt前肾小球滤过率下降7.17点相关（95% CI = - 14.35 ~ - 0.02, p = 0.05），校正CTP C、年龄、性别、糖尿病、高血压、lt前肌肉减少症和肝细胞癌。lt前VSR升高不影响lt后3年死亡率（log-rank p = 0.24）。身体质量指数表现不佳，内脏脂肪在肝硬化中增加，并与CTP类型相关。然而，这种脂肪的再分配可以通过LT来改变。
Changes in adipose tissue distribution in liver cirrhosis are poorly characterized and may affect clinical outcomes. Adult liver transplant (LT) January 2008–August 2017 recipients with abdominal MRI within 6 months pre-LT were retrospectively assessed. Visceral adipose tissue, subcutaneous adipose tissue, and skeletal muscle area (cm2) were determined at L3. Visceral-to-subcutaneous adipose tissue ratio (VSR) was used to define relative adipose distribution, stratified by sex. Correlation was tested with Pearson. Body composition measures were compared by Child-Turcotte-Pugh (CTP) class, before and after LT, and evaluated as predictors of clinical outcomes. A total of 318 patients were studied. Mean age was 56 years, 33.64% were female, and 47.80% had CTP C cirrhosis. CTP C was associated with a 0.42-point increase in VSR compared with CTP A (95% CI = 0.13–0.71, p < 0.01), adjusting for age, sex, diabetes, and HCC. Among the 79 (24.84%) patients with repeat MRI 1–2 years after LT, VSR significantly improved from before LT (1.31 vs. 0.95, p < 0.01). In adjusted analysis, CTP C was associated with a 0.86-point decrease in post-LT VSR compared with pre-LT VSR (95% CI = −1.27 to −0.44, p < 0.01). Body mass index poorly correlated with VSR before and after LT. Elevated pre-LT VSR trended toward an association with a 7.17-point decrease in pre-LT glomerular filtration rate (95% CI = −14.35 to −0.02, p = 0.05), adjusting for CTP C, age, sex, diabetes, hypertension, pre-LT sarcopenia, and hepatocellular carcinoma. Elevated pre-LT VSR did not affect 3-year post-LT mortality (log-rank p = 0.24). Poorly represented by body mass index, visceral adiposity is increased in cirrhosis and is associated with CTP class. However, this adipose redistribution may be modifiable by LT.