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肝硬化患者营养不良、肌肉减少症及骨质疏松的防治

肖慧娟 韩涛

引用本文:
Citation:

肝硬化患者营养不良、肌肉减少症及骨质疏松的防治

DOI: 10.3969/j.issn.1001-5256.2021.01.006
基金项目: 

国家十三五科技重大专项 (2017ZX10203201-007)

作者贡献声明:肖慧娟负责收集分析资料,撰写论文;韩涛拟定写作思路,指导文章撰写及修改并最后定稿。
详细信息
    作者简介:

    肖慧娟(1983—),女,在读博士,主要从事消化系统疾病、肝病的营养诊疗和代谢研究

    通信作者:

    韩涛,hantaomd@126.com

  • 中图分类号: R575.2

Prevention and treatment of malnutrition, sarcopenia, and osteoporosis in patients with liver cirrhosis

  • 摘要: 营养不良、肌肉减少症(肌少症)及骨质疏松是肝硬化患者常见的营养相关并发症,肌少症是营养不良的重要表现,而营养不良、肌少症又是骨质疏松发生的危险因素,三者相互关系密切,且都对肝硬化患者的临床结局和预后产生不良影响,故要及早发现,积极防治。营养物质摄入不足、代谢紊乱、激素水平异常、身体活动缺乏等促使肝硬化患者易出现营养不良、肌少症及骨质疏松。此外,肝病治疗常用药物如糖皮质激素、某些抗病毒药物等可能影响骨代谢,需引起临床关注。合理的营养干预、适当的运动和基础疾病的治疗是防治营养不良、肌少症及骨质疏松的基础。一些针对性治疗药物可有助于改善患者的上述营养相关并发症,但仍需进一步研究证实。

     

  • [1] CAMPILLO B, RICHARDET JP, SCHERMAN E, et al. Evaluation of nutritional practice in hospitalized cirrhotic patients: Results of a prospective study[J]. Nutrition, 2003, 19(6): 515-521. DOI: 10.1016/S0899-9007(02)01071-7
    [2] GUGLIELMI FW, PANELLA C, BUDA A, et al. Nutritional state and energy balance in cirrhotic patients with or without hypermetabolism.Multicentre prospective study by the'Nutritional Problems in Gastroenterology'Section of the Italian Society of Gastroenterology (SIGE)[J]. Dig Liver Dis, 2005, 37(9): 681-688. DOI: 10.1016/j.dld.2005.03.010
    [3] CRUZ-JENTOFT AJ, BAEYENS JP, BAUER JM, et al. Sarcopenia:European consensus on definition and diagnosis: Report of the European Working Group on sarcopenia in older people[J]. Age Ageing, 2010, 39(4): 412-423. DOI: 10.1093/ageing/afq034
    [4] PERIYALWAR P, DASARATHY S.Malnutrition in cirrhosis:Contribution and consequences of sarcopenia on metabolic and clinical responses[J]. Clin Liver Dis, 2012, 16(1): 95-131. DOI: 10.1016/j.cld.2011.12.009
    [5] PONZIANI FR, GASBARRINI A.Sarcopenia in patients with advanced liver disease[J]. Curr Protein Pept Sci, 2018, 19(7): 681-691. DOI: 10.2174/1389203718666170428121647
    [6] TANDON P, NEY M, IRWIN I, et al. Severe muscle depletion in patients on the liver transplant wait list:Its prevalence and independent prognostic value[J]. Liver Transpl, 2012, 18(10): 1209-1216. DOI: 10.1002/lt.23495
    [7] XIAO HJ, YE Q, HAN T, et al. Risk factors for sarcopenia and its impact on clinical outcome in patients with liver cirrhosis[J]. Chin J Hepatol, 2020, 28(1): 53-57(in Chinese)

    肖慧娟, 叶青, 韩涛, 等. 肝硬化合并肌肉减少症的危险因素及其对临床结局的影响[J]. 中华肝脏病杂志, 2020, 28(1): 53-57.
    [8] WELCH N, DASARATHY J, RUNKANA A, et al. Continued muscle loss increases mortality in cirrhosis:Impact of aetiology of liver disease[J]. Liver Int, 2020, 40(5): 1178-1188. DOI: 10.1111/liv.14358
    [9] EBADI M, MONTANO-LOZA AJ. Sarcopenia and frailty in the prognosis of patients on the liver transplant waiting list[J]. Liver Transpl, 2019, 25(1): 7-9. DOI: 10.1002/lt.25386
    [10] PLAUTH M, BERNAL W, DASARATHY S, et al. ESPEN guideline on clinical nutrition in liver disease[J]. Clin Nutr, 2019, 38(2): 485-521. DOI: 10.1016/j.clnu.2018.12.022
    [11] SINCLAIR M, GOW PJ, GROSSMANN M, et al. Review article:Sarcopenia in cirrhosis aetiology, implications and potential therapeutic interventions[J]. Aliment Pharmacol Ther, 2016, 43(7): 765-777. DOI: 10.1111/apt.13549
    [12] MONTANO-LOZA AJ, DUARTE-ROJO A, MEZA-JUNCO J, et al. Inclusion of sarcopenia within MELD (MELD-Sarcopenia) and the prediction of mortality in patients with cirrhosis[J]. Clin Transl Gastroenterol, 2015, 6(7): e102. DOI: 10.1038/ctg.2015.31
    [13] LUPOLI R, di MINNO A, SPADARELLA G, et al. The risk of osteoporosis in patients with liver cirrhosis: A meta-analysis of literature studies[J]. Clin Endocrinol (Oxf), 2016, 84(1): 30-38. DOI: 10.1111/cen.12780
    [14] JEONG HM, KIM DJ. Bone diseases in patients with chronic liver disease[J]. Int J Mol Sci, 2019, 20(17): 1-27. http://www.ncbi.nlm.nih.gov/pubmed/31480433
    [15] HAYASHI M, ABE K, FUJITA M, et al. Association between sarcopenia and osteoporosis in chronic liver disease[J]. Hepatol Res, 2018, 48(11): 893-904. DOI: 10.1111/hepr.13192
    [16] DUAN ZP. Clinical recommendations to address malnutrition in patients with end-stage liver disease[J]. Chin J Hepatol, 2013, 21(10): 721-722.(in Chinese) DOI: 10.3760/cma.j.issn.1007-3418.2013.10.001

    段钟平. 应重视终末期肝病的营养不良问题[J]. 中华肝脏病杂志, 2013, 21(10): 721-722. DOI: 10.3760/cma.j.issn.1007-3418.2013.10.001
    [17] CHEUNG K, LEE SS, RAMAN M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies[J]. Clin Gastroenterol Hepatol, 2012, 10(2): 117-125. DOI: 10.1016/j.cgh.2011.08.016
    [18] QIU J, THAPALIYA S, RUNKANA A, et al. Hyperammonemia in cirrhosis induces transcriptional regulation of myostatin by an NF-kappa B-mediated mechanism[J]. Proc Natl Acad Sci USA, 2013, 110(45): 18162-18167. DOI: 10.1073/pnas.1317049110
    [19] Chinese Society of Infectious Diseases, Chinese Medical Association; Chinese Society of Hepatology, Chinese Medical Association.Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.12.007

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669 DOI: 10.3969/j.issn.1001-5256.2019.12.007
    [20] European Association for the Study of the Liver.EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67(2): 370-398. DOI: 10.1016/j.jhep.2017.03.021
    [21] European Association for the Study of the Liver.EASL Clinical Practice Guidelines on nutrition in chronic liver disease[J]. J Hepatol, 2019, 70(1): 172-193. DOI: 10.1016/j.jhep.2018.06.024
    [22] CAREY EJ, LAI JC, WANG CW, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease[J]. Liver Transpl, 2017, 23(5): 625-633. DOI: 10.1002/lt.24750
    [23] NISHIKAWA H, SHIRAKI M, HIRAMATSU A, et al. Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria[J]. Hepatol Res, 2016, 46(10): 951-963. DOI: 10.1111/hepr.12774
    [24] Chinese Society of Osteoporosis and Bone Mineral Research.Sarcopenia consensus[J]. Chin J Osteoporosis Bone Miner Res, 2016, 9(3): 215-227.(in Chinese) DOI: 10.3969/j.issn.1674-2591.2016.03.001

    中华医学会骨质疏松和骨矿盐疾病分会. 肌少症共识[J]. 中华骨质疏松和骨矿盐疾病杂志, 2016, 9(3): 215-227 DOI: 10.3969/j.issn.1674-2591.2016.03.001
    [25] Chinese Society of Hepatology, Chinese society of Gastroenterology, Chinese Medical Association.Clinical guidelines on nutrition in end-stage liver disease[J]. J Clin Hepatol, 2019, 35(6): 1222-1230.(in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.06.010

    中华医学会肝病学分会, 中华医学会消化病学分会. 终末期肝病临床营养指南[J]. 临床肝胆病杂志, 2019, 35(6): 1222-1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010
    [26] BAJAJ JS, LAURIDSEN M, TAPPER EB, et al. Important unresolved questions in the management of hepatic encephalopathy: An ISHEN consensus[J]. Am J Gastroenterol, 2020, 115(7): 989-1002. http://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CJFD&filename=DQHB202006004
    [27] DUARTE-ROJO A, RUIZ-MARGÁIN A, MONTAÑO-LOZA AJ, et al. Exercise and physical activity for patients with end-stage liver disease:Improving functional status and sarcopenia while on the transplant waiting list[J]. Liver Transpl, 2018, 24(1): 122-139. DOI: 10.1002/lt.24958
    [28] SINCLAIR M, GROSSMANN M, HOERMANN R, et al. Testosterone therapy increases muscle mass in men with cirrhosis and low testosterone:A randomised controlled trial[J]. J Hepatol, 2016, 65(5): 906-913. DOI: 10.1016/j.jhep.2016.06.007
    [29] GRECH A, BRECK J, HEIDELBAUGH J.Adverse effects of testosterone replacement therapy:An update on the evidence and controversy[J]. Ther Adv Drug Saf, 2014, 5(5): 190-200. DOI: 10.1177/2042098614548680
    [30] KUMAR A, DAVULURI G, SILVA R, et al. Ammonia lowering reverses sarcopenia of cirrhosis by restoring skeletal muscle proteostasis[J]. Hepatology, 2017, 65(6): 2045-2058. DOI: 10.1002/hep.29107
    [31] SHARMA BC, SHARMA P, LUNIA MK, et al. A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy[J]. Am J Gastroenterol, 2013, 108(9): 1458-1463. DOI: 10.1038/ajg.2013.219
    [32] DASARATHY S, MCCULLOUGH AJ, MUC S, et al. Sarcopenia associated with portosystemic shunting is reversed by follistatin[J]. J Hepatol, 2011, 54(5): 915-921. DOI: 10.1016/j.jhep.2010.08.032
    [33] WOODHOUSE L, GANDHI R, WARDEN SJ, et al. A phase 2 randomized study investigating the efficacy and safety of myostatin antibody LY2495655 versus placebo in patients undergoing elective total hip arthroplasty[J]. J Frailty Aging, 2016, 5(1): 62-70. http://europepmc.org/abstract/MED/26980371
    [34] TSIEN C, SHAH SN, MCCULLOUGH AJ, et al. Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent[J]. Eur J Gastroenterol Hepatol, 2013, 25(1): 85-93. DOI: 10.1097/MEG.0b013e328359a759
    [35] Chinese Society of Bone Nutrition and Health, Chinese Society of Osteoporosis and Bone Mineral Research.Expert consensus on nutrition and exercise management in patients with primary osteoporosis[J]. Chin J Endocrinol Metab, 2020, 36(8): 643-653.(in Chinese) DOI: 10.3760/cma.j.cn311282-20200408-00261

    中国营养学会骨营养与健康分会, 中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症患者的营养和运动管理专家共识[J]. 中华内分泌代谢杂志, 2020, 36(8): 643-653. DOI: 10.3760/cma.j.cn311282-20200408-00261
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  • 收稿日期:  2020-10-05
  • 录用日期:  2020-11-14
  • 出版日期:  2021-01-20
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