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Association between muscle loss and nutritional risk in patients with liver cirrhosis or hepatocellular carcinoma
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摘要:
目的探究肝硬化及肝细胞癌患者腰肌橫向厚度指数（TPTI）与患者发生营养风险的相关性。方法选取2018年1月-2019年1月于天津市第三中心医院住院，并行腹部CT的肝硬化及肝细胞癌患者共151例，根据纳入及排除标准筛选研究对象，分为单纯肝硬化组（n=95）和肝细胞癌组（n=56）。应用营养风险筛查2002（NRS-2002）将肝硬化、肝细胞癌患者分别分为有营养风险组、无营养风险组。收集身高、体质量、肝功能及TPTI等临床数据。计量资料两组间比较采用t检验或Mann-Whitney U检验，计数资料两组间比较采用χ2检验、趋势χ2检验。采用logistic回归分析肝硬化及肝细胞癌患者发生营养风险的相关因素。结果Child-Pugh A级、B级、C级单纯肝硬化患者营养风险发生率分别为61.2%、80.6%、86.7%，肝细胞癌患者营养风险发生率分别为44.4%、84.6%、85.7%。趋势χ2检验及Spearman相关分析显示，随着肝功能储备下降，肝硬化、肝细胞癌患者营养风险发生率呈上升趋势（χ2=5.051，P=0.025；r=0.388，P=0.003）。肝硬化及肝细胞癌患者的TPTI值在有营养风险组患者中均显著低于无营养风险组患者（P值均＜0.05）。肝硬化组患者中，logistic回归模型调整Alb水平后，TPTI值越高，患者发生营养风险的可能性越低（比值比=0.766，95%可信区间：0.642~0.915）。结论随着肝功能储备下降，肝硬化及肝细胞癌患者营养风险发生率呈上升趋势。肝硬化患者中，TPTI值越高，患者发生营养风险的可能性越低。肝细胞癌患者中，有营养风险的患者TPTI值较低。
Abstract:ObjectiveTo investigate the association between transversal psoas thickness index (TPTI) and nutritional risk in patients with liver cirrhosis or hepatocellular carcinoma (HCC). MethodsThe patients with liver cirrhosis or HCC who were admitted to Tianjin Third Central Hospital from January 2018 to January 2019 and underwent abdominal CT examination were enrolled, and according to the inclusion and exclusion criteria, the patients were screened and divided into liver cirrhosis group and HCC group. The patients with liver cirrhosis or HCC were divided into nutritional risk group and non-nutritional risk group according to the results of Nutritional Risk Screening 2002. Related clinical data, including body height, body weight, liver function, and TPTI were collected. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test and the trend chi-square test were used for comparison of categorical data between two groups. A logistic regression analysis was used to analyze the factors for nutritional risk in patients with liver cirrhosis or HCC. ResultsA total of 151 patients were enrolled in this study, with 95 patients in the liver cirrhosis group and 56 patients in the HCC group. The incidence rates of nutritional risk in patients with Child-Pugh class A/B/C liver cirrhosis were 61.2%, 80.6%, and 86.7%, respectively, and those in patients with Child-Pugh A/B/C HCC were 44.4%, 84.6%, and 85.7%, respectively. The trend chi-square test and the Spearman correlation analysis showed that the incidence rate of nutritional risk tended to increase with the reduction in liver function reserve in patients with liver cirrhosis or HCC (χ2=5.051, P=0.025; r=0.388, P=0.003). For the patients with liver cirrhosis or HCC, the nutritional risk group had a significantly lower TPTI than the non-nutritional risk group (both P＜0.05). For the patients in the liver cirrhosis group, after adjustment for albumin level in the logistic regression model, the higher the TPTI value, the lower the possibility of nutritional risk in patients (odds ratio=0.766, 95% confidence interval: 0.642-0.915). ConclusionThe incidence rate of nutritional risk in patients with liver cirrhosis or HCC tends to increase with the reduction in liver function reserve. For patients with liver cirrhosis, the higher the TPTI value, the lower the possibility of nutritional risk; for patients with HCC, those with nutritional risk have a lower TPTI value.
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