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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Fat‐free muscle mass in magnetic resonance imaging predicts acute‐on‐chronic liver failure and survival in decompensated cirrhosis
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Fat‐free muscle mass in magnetic resonance imaging predicts acute‐on‐chronic liver failure and survival in decompensated cirrhosis

机译：磁共振成像中无脂肪肌肉质量预测急性慢性肝功能衰竭和代解偿性肝硬化的生存

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摘要

Muscle mass seems to be a prognostic marker in patients with liver cirrhosis. However, reported methods to quantify muscle mass are heterogeneous, consented cutoff values are missing, and most studies have used computed tomography. This study evaluated fat‐free muscle area (FFMA) as a marker of sarcopenia using magnetic resonance imaging (MRI) in patients with decompensated cirrhosis with transjugular intrahepatic portosystemic shunt (TIPS). The total erector spinae muscle area and the intramuscular fat tissue area were measured and subtracted to calculate the FFMA in 116 patients with cirrhosis by TIPS and MRI. The training cohort of 71 patients compared computed tomography–measured transversal psoas muscle thickness with FFMA. In 15 patients MRI was performed before and after TIPS, and in 12 patients follistatin serum measurements were carried out. The results on FFMA were confirmed in a validation cohort of 45 patients. FFMA correlated with follistatin and transversal psoas muscle thickness and showed slightly better association with survival than transversal psoas muscle thickness. Gender‐specific cutoff values for FFMA were determined for sarcopenia. Decompensation (ascites, overt hepatic encephalopathy) persisted after TIPS in the sarcopenia group but resolved in the nonsarcopenia group. Sarcopenic patients showed no clinical improvement after TIPS as well as higher mortality, mainly due to development of acute‐on‐chronic liver failure. FFMA was an independent predictor of survival in these patients. Conclusion: This study offers an easy‐to‐apply MRI‐based measurement of fat‐free muscle mass as a marker of sarcopenia in decompensated patients; while TIPS might improve sarcopenia and thereby survival, persistence of sarcopenia after TIPS is associated with a reduced response to TIPS and a higher risk of acute‐on‐chronic liver failure development and mortality. (H epatology 2018;67:1014–1026)
机译：肌肉肿块似乎是肝硬化患者的预后标志物。然而，报道的量化肌肉质量是异构的，缺失同意的截止值，并且大多数研究使用了计算机断层扫描。本研究评估了使用磁共振成像（MRI）在具有Dradjuarular肝内雌激素分流（提示）的患者中使用磁共振成像（MRI）作为SARCOPENIA的肥胖肌面积（FFMA）作为SARCOPENIA的标志物。测量并减去总射击素肌面和肌内脂肪组织面积，以通过提示和MRI计算116例肝硬化患者的FFMA。 71例患者的培训队列比较了计算断层摄影测量的横向PSOA肌厚度，具有FFMA。在15名患者中，MRI在提示之前和之后进行，并在12例患者中进行了Follistatin血清测量。在45名患者的验证队列中证实了FFMA的结果。 FFMA与Follistatin和横向PSOAS肌肉厚度相关，并且与横向PSOA肌厚度略微更好地与存活率相关。针对SARCOPENIA确定FFMA的性别特异性截止值。在嗜睡组中的尖端后持续存在的失代偿（腹水，公开的肝病症），但在非露天尼亚群体中得到解决。麻疯病患者在提示后没有临床改善，以及更高的死亡率，主要是由于急性慢性肝衰竭的发展。 FFMA是这些患者的生存的独立预测因子。结论：本研究提供易于使用的MRI的无脂肪肌肉质量测量作为失代偿患者的SARCOPENIA标志物;虽然提示可能会改善肌肉衰老，从而在提示后持续存在的持续存在，持续的康迟症与对尖端的反应减少以及急性慢性肝功能衰竭发育和死亡率的较高风险。 （2018年高潮; 67：1014-1026）

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