Sarcopenia in Children With End-Stage Liver Disease
Sarcopenia in Children With End-Stage Liver Disease
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DOI：
10.1097/mpg.0000000000001792
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发表时间：
2018-02-01
影响因子：
2.9
通讯作者：
Ng, Vicky L.
中科院分区：
文献类型：
--
作者：
Lurz, Eberhard;Patel, Hiten;Ng, Vicky L.
背景资料：腰大肌表面积（PMSA）减少反映的肌肉减少症已被确定为成人肝移植（LT）等待名单死亡率和结局的一种新的独立预测因子。我们假设，儿童与终末期肝病（ESLD）将有较小的PMSA比健康controls.Methods：计算机断层扫描图像的儿童（年龄0至18岁）列出的LT在2015年和对照组包括2：1年龄和性别匹配的健康儿科创伤受害者进行了审查。在2个椎间盘（L3/4; L4/5）节段测定PMSA。一个子集的图像进行了审查，由2名放射科医生，以确定interrater correlation.Results：共23名儿童与ESLD包括在内，最常见的诊断是胆道闭锁（61%）。在两个腰椎水平上，ESLD受试者的中位PMSA显著小于46名健康对照者（L4/5;中位总PMSA（tPMSA）407 mm（2）（四分位距339-537）vs对照者513 mm（2）（四分位距437-672）; P=0.004），与受试者的体重z评分无关（r=0.01; P=0.95）。良好的评分者间相关性（组内相关性0.99）。结论：在这项回顾性初步研究中，与健康的年龄和性别匹配的对照组相比，ESLD儿童的PMSA显着降低。由于这一发现与ESLD受试者的生长无关，PMSA可能代表晚期肝病儿童的一种新的客观营养生物标志物。
Background: Sarcopenia, reflected by decreased psoas muscle surface area (PMSA), has been identified as a novel and independent predictor of wait-list mortality and outcomes in adult liver transplantation (LT). We hypothesized that children with end-stage liver disease (ESLD) would have smaller PMSA than healthy controls.Methods: Computer tomography images of children (ages 0 to 18 years) listed for LT in 2015 and a control group comprised 2:1 age- and gender-matched healthy pediatric trauma victims were reviewed. PMSA was determined at 2 intervertebral disc (L3/4; L4/5) levels. A subset of images was reviewed by 2 radiologists to determine interrater correlation.Results: A total of 23 children with ESLD were included, and the most prevalent diagnosis was biliary atresia (61%). On both lumbar levels, median PMSA was significantly smaller in ESLD subjects compared with the 46 healthy controls (L4/5; median total PMSA (tPMSA) 407 mm(2) (interquartile range 339-537) versus controls 513 mm(2) (interquartile range 437-672); P=0.004), independent of participants' weight z scores (r=0.01; P=0.95). Excellent interrater correlation was seen (intraclass correlation 0.99).Conclusions: In this retrospective pilot study, PMSA was significantly lower in children with ESLD compared with healthy age- and gender-matched controls. Because this finding was independent of growth in ESLD subjects, PMSA may represent a novel objective nutritional biomarker in children with advanced liver disease.