肝硬化合并肌少症的临床指标探讨

Discussion on Clinical Indicators of Liver Cirrhosis Complicated with Sarcopenia

摘要: 目的：探讨相关临床指标对肝硬化合并肌少症的诊断价值，以便临床早期干预，改善患者预后。方法：回顾性分析2015年1月至2015年12月在青岛大学附属医院住院治疗的193例肝硬化患者，根据骨骼肌指数(skeletal muscle index, SMI)分为肌少症组与非肌少症组，比较两组患者的一般资料、实验室资料及影像资料。用Spearman分析两连续变量相关性，筛选出诊断指标，并进行受试者工作特征(ROC)曲线分析得到最佳诊断值。结果：纳入193例肝硬化患者，其中男性117例(60.62%)，年龄(51.23 ± 10.98)岁，女性76例(39.38%)，年龄(59.96 ± 11.71)岁，非肌少症组108例(55.96%)，肌少症组85例(44.04%)。与非肌少症组相比，肌少症患者的中性粒细胞计数、中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值、尿素氮/肌酐比值、碱性磷酸酶更高，而淋巴细胞计数、淋巴细胞/单核细胞比值较非肌少症组低；影像学指标中肌少症患者的骨骼肌肉面积、皮下脂肪面积、皮下脂肪指数显著更低，而内脏皮下脂肪比相对较高，差异有统计学意义(P < 0. 05)。SMI与体质指数(body mass index, BMI)、淋巴细胞计数、骨骼肌肉面积、内脏皮下脂肪比、中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值、尿素氮/肌酐比值、碱性磷酸酶存在线性相关关系(P < 0.05)。ROC曲线分析提示BMI、淋巴细胞数、中性粒细胞/淋巴细胞比、血小板/淋巴细胞比、尿素氮/肌酐比、碱性磷酸酶等指标对诊断肌少症具有较好价值。结论：BMI、淋巴细胞数、中性粒细胞/淋巴细胞比、血小板/淋巴细胞比、尿素氮/肌酐比、碱性磷酸酶等指标可用于临床筛查肝硬化患者是否合并肌少症。

Abstract: Objective: To explore the diagnostic value of relevant clinical indicators for liver cirrhosis complicated with sarcopenia, in order to conduct early clinical intervention and improve the prognosis of patients. Methods: A retrospective analysis was conducted on 193 patients with liver cirrhosis who were hospitalized in Qingdao University Affiliated Hospital from January 2015 to December 2015. The patients were divided into sarcopenia group and non-sarcopenia group based on skeletal muscle index (SMI). The general data, laboratory data and imaging data of the two groups were compared. Spearman analysis was used to analyze the correlation between two continuous variables, and the diagnostic indicators were screened out. The receiver operating characteristic (ROC) curve analysis was conducted to obtain the optimal diagnostic value. Results: A total of 193 patients with liver cirrhosis were included. Among them, 117 cases (60.62%) were male, and the age was (51.23 ± 10.98) years. 76 cases (39.38%) were female, and the age was (59.96 ± 11.71) years. 108 cases (55.96%) were in the non-sarcopenia group, and 85 cases (44.04%) were in the sarcopenia group. Compared with the non-sarcopenia group, the neutrophil count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, urea nitrogen/creatinine ratio, and alkaline phosphatase were higher in the sarcopenia group, while the lymphocyte count and lymphocyte/monocyte ratio were lower. In imaging indicators, the skeletal muscle area, subcutaneous fat area, and subcutaneous fat index of the sarcopenia group were significantly lower, while the visceral subcutaneous fat ratio was relatively higher. The differences were statistically significant (P < 0.05). There was a linear correlation between SMI and body mass index (BMI), lymphocyte count, skeletal muscle area, visceral subcutaneous fat ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, urea nitrogen/creatinine ratio, and alkaline phosphatase (P < 0.05). ROC curve analysis suggested that BMI, lymphocyte count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, urea nitrogen/creatinine ratio, and alkaline phosphatase were of good value for diagnosing sarcopenia. Conclusion: BMI, lymphocyte count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, urea nitrogen/creatinine ratio, and alkaline phosphatase can be used for clinical screening of whether liver cirrhosis patients are complicated with sarcopenia.