终末期肝病和肝移植后的肌肉减少症。

IF 1.3 4区 医学 Q4 GASTROENTEROLOGY & HEPATOLOGY
S Leunis, M Vandecruys, A H Van Craenenbroeck, V Cornelissen, S Bogaerts, S De Smet, D Monbaliu
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引用次数: 0

摘要

骨骼肌减少症发生在30-70%的终末期肝病患者中,并与肝移植前和移植后较差的预后相关,如插管时间延长、重症监护和住院时间延长、移植后感染风险增加、健康相关生活质量降低和死亡率增加。肌少症的发病机制是多因素的,涉及生化紊乱,如高氨血症、低血清支链氨基酸(BCAAs)浓度和低血清睾酮水平,以及慢性炎症、营养状况不足和缺乏运动。及时识别和准确评估肌肉减少症是至关重要的,需要影像学、动力测量和物理性能测试来评估其子成分:肌肉质量、肌肉力量和肌肉功能。肝移植大多不能逆转肌肉减少症患者的肌肉减少症。事实上,一些患者在接受肝移植后会出现肌肉减少症。肌少症的推荐治疗是多模式的,包括运动治疗和补充营养干预的结合。此外,新的药理学药物(如肌生长抑制素抑制剂、睾酮补充剂和降氨疗法)正在临床前研究中进行调查。在此,我们对肝移植前后终末期肝病患者肌肉减少症的定义、评估和处理进行了综述。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sarcopenia in end-stage liver disease and after liver transplantation.

Sarcopenia occurs in 30-70% of patients with end-stage liver disease and is associated with inferior pre- and post-liver transplant outcomes such as prolonged intubation times, long intensive care and hospitalization times, heightened risk of post-transplant infection, reduced health-related quality of life, and increased rates of mortality. The pathogenesis of sarcopenia is multifactorial and involves biochemical disturbances such as hyperammonemia, low serum concentrations of branched-chain amino acids (BCAAs) and low serum levels of testosterone, as well as chronic inflammation, inadequate nutritional status, and physical inactivity. Prompt recognition and accurate assessment of sarcopenia are critical and require imaging, dynamometry, and physical performance testing for the assessment of its subcomponents: muscle mass, muscle strength, and muscle function, respectively. Liver transplantation mostly fails to reverse sarcopenia in sarcopenic patients. In fact, some patients develop de novo sarcopenia after undergoing liver transplantation. The recommended treatment of sarcopenia is multimodal and includes a combination of exercise therapy and complementary nutritional interventions. Additionally, new pharmacological agents (e.g. myostatin inhibitors, testosterone supplements, and ammonia-lowering therapy) are under investigation in preclinical studies. Here, we present a narrative review of the definition, assessment, and management of sarcopenia in patients with end-stage liver disease prior to and after liver transplantation.

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来源期刊
Acta gastro-enterologica Belgica
Acta gastro-enterologica Belgica Medicine-Gastroenterology
CiteScore
2.30
自引率
20.00%
发文量
78
期刊介绍: The Journal Acta Gastro-Enterologica Belgica principally publishes peer-reviewed original manuscripts, reviews, letters to editors, book reviews and guidelines in the field of clinical Gastroenterology and Hepatology, including digestive oncology, digestive pathology, as well as nutrition. Pure animal or in vitro work will not be considered for publication in the Journal. Translational research papers (including sections of animal or in vitro work) are considered by the Journal if they have a clear relationship to or relevance for clinical hepato-gastroenterology (screening, disease mechanisms and/or new therapies). Case reports and clinical images will be accepted if they represent an important contribution to the description, the pathogenesis or the treatment of a specific gastroenterology or liver problem. The language of the Journal is English. Papers from any country will be considered for publication. Manuscripts submitted to the Journal should not have been published previously (in English or any other language), nor should they be under consideration for publication elsewhere. Unsolicited papers are peer-reviewed before it is decided whether they should be accepted, rejected, or returned for revision. Manuscripts that do not meet the presentation criteria (as indicated below) will be returned to the authors. Papers that go too far beyond the scope of the journal will be also returned to the authors by the editorial board generally within 2 weeks. The Journal reserves the right to edit the language of papers accepted for publication for clarity and correctness, and to make formal changes to ensure compliance with AGEB’s style. Authors have the opportunity to review such changes in the proofs.
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