Association between pre-sarcopenia, sarcopenia, and bone mineral density in patients with chronic hepatitis C.
Association between pre-sarcopenia, sarcopenia, and bone mineral density in patients with chronic hepatitis C.
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DOI：
10.1002/jcsm.12269
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Silva LD
中科院分区：
文献类型：
--
作者：
Bering T;Diniz KGD;Coelho MPP;Vieira DA;Soares MMS;Kakehasi AM;Correia MITD;Teixeira R;Queiroz DMM;Rocha GA;Silva LD
保存的骨骼肌对于维持健康的骨骼至关重要。骨矿物质密度 (BMD) 和肌肉力量的丧失被认为是 BMD 的预测因子，已在肝硬化患者中得到证实，但在无肝硬化的慢性丙型肝炎 (CHC) 中却很少研究。因此，我们的目的是评估 CHC 中低 BMD 的患病率及其与身体成分、肌肉力量和营养状况的关系。一百零四名受试者[平均年龄，50.5 ± 11.3 岁； 75.0% 男性； 67.3% 非肝硬化； 32.7% 的代偿性肝硬化]使用 CHC，前瞻性地通过双能 X 射线骨密度仪扫描瘦组织、四肢骨骼肌质量 (ASM)、脂肪量、腰椎、髋部、股骨颈和全身 BMD。通过测力法评估肌肉力量。根据欧洲老年人肌少症工作组的标准，肌少症的定义是存在低 ASM/身高 2 (ASMI) 和低肌力。女性和男性的低 ASMI 和低肌肉力量的截止点分别为 < 5.45 和 < 7.26 kg/m2 以及 < 20 和 < 30 kg。根据世界卫生组织采用的50岁以上男性标准，男性骨质减少的T分数低于年轻平均值-1.0至-2.49标准差（SD），骨质疏松的T分数低于年轻平均平均值≥-2.5标准差，而低骨量的Z分数低于50岁以下男性和女性的预期范围≤-2.0标准偏差。营养状况评估基于控制营养状况评分。低骨密度、低肌力、肌少症前期、肌少症和肌少症肥胖的比例分别为 34.6% (36/104)、27.9% (29/104)、14.4% (15/104)、8.7% (9/104) 和 3.8% (4/104)。 ASMI 是 BMD 的独立预测因子 (P < 0.001)。肌肉减少症与骨矿物质含量（P = 0.02）和营养不良（P = 0.01）独立相关。 88.9% 的肌肉减少症患者和所有肌肉减少症肥胖患者的 BMI 正常。中臂肌围与 ASMI 呈正相关（r = 0.88；P < 0.001）。这是第一项证明 ASM 是 CHC 中 BMD 的独立预测因子的研究。应将中臂肌肉周长与握力测试结合到常规临床实践中，以检测低肌肉质量，而仅使用 BMI 时可能会漏诊。这些发现可能会影响临床决策，并有助于制定有效的策略来筛查 CHC 患者的肌肉骨骼异常，而与肝病的阶段无关。
Preserved skeletal muscle is essential for the maintenance of healthy bone. Loss of bone mineral density (BMD) and muscle strength, considered a predictor of BMD, have been demonstrated in patients with cirrhosis, but they are poorly studied in chronic hepatitis C (CHC) without cirrhosis. Thus, we aimed to evaluate the prevalence of low BMD and its association with body composition, muscle strength, and nutritional status in CHC. One hundred and four subjects [mean age, 50.5 ± 11.3 years; 75.0% males; 67.3% non‐cirrhotic; and 32.7% with compensated cirrhosis] with CHC, prospectively, underwent scanning of the lean tissue, appendicular skeletal muscle mass (ASM), fat mass, lumbar spine, hip, femoral neck, and whole‐body BMD by dual‐energy X‐ray absorptiometry. Muscle strength was assessed by dynamometry. Sarcopenia was defined by the presence of both low, ASM/height2 (ASMI) and low muscle strength according to the European Working Group on Sarcopenia in Older People criteria. The cut‐off points for low ASMI and low muscle strength, for women and men, were < 5.45 and < 7.26 kg/m2 and < 20 and < 30 kg, respectively. According to the adopted World Health Organization criteria in men aged > 50 years, the T‐score of osteopenia is between −1.0 and −2.49 standard deviation (SD) below the young average value and of osteoporosis is ≥−2.5 SD below the young normal mean for men, and the Z‐score of low bone mass is ≤−2.0 SD below the expected range in men aged < 50 years and women in the menacme. Nutritional status evaluation was based on the Controlling Nutritional Status score. Low BMD, low muscle strength, pre‐sarcopenia, sarcopenia, and sarcopenic obesity were observed in 34.6% (36/104), 27.9% (29/104), 14.4% (15/104), 8.7% (9/104), and 3.8% (4/104) of the patients, respectively. ASMI was an independent predictor of BMD (P < 0.001). Sarcopenia was independently associated with bone mineral content (P = 0.02) and malnutrition (P = 0.01). In 88.9% of the sarcopenic patients and in all with sarcopenic obesity, BMI was normal. The mid‐arm muscle circumference was positively correlated with ASMI (r = 0.88; P < 0.001). This is the first study to demonstrate that ASM is an independent predictor of BMD in CHC. Mid‐arm muscle circumference coupled with handgrip strength testing should be incorporated into routine clinical practice to detect low muscle mass, which may be underdiagnosed when only BMI is used. These findings may influence clinical decision‐making and contribute to the development of effective strategies to screen the musculoskeletal abnormalities in CHC patients, independently of the stage of the liver disease.
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影响因子：
2.5
作者：
Gowda C;Compher C;Amorosa VK;Lo Re V 3rd
通讯作者：
Lo Re V 3rd
DOI：
10.1164/rccm.200406-754oc
发表时间：
2004-12-15
影响因子：
24.7
作者：
Bolton, CE;Ionescu, AA;Shale, DJ
通讯作者：
Shale, DJ
影响因子：
7
作者：
Heymsfield, Steven B.;Gonzalez, M. Cristina;Zheng, Jolene
通讯作者：
Zheng, Jolene
影响因子：
3.1
作者：
Hallal, Pedro C.;Cordeira, Kelly;Victora, Cesar G.
通讯作者：
Victora, Cesar G.
DOI：
10.1002/jbmr.1969
发表时间：
2013-07
期刊：
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
影响因子：
--
作者：
DiGirolamo DJ;Kiel DP;Esser KA
通讯作者：
Esser KA