Study On The Correlation Between Muscle Loss And Nutritional Risk In Patients With Liver Cirrhosis Or Hepatocellular Carcinoma

Objective:To evaluate nutritional risk in patients with liver cirrhosis and hepatocellular carcinoma;Analysis of the related factors affecting nutritional risk in patients with liver cirrhosis or hepatocellular carcinoma;and the correlation between muscle-related factor and nutritional risk.Methods:Patients with liver cirrhosis and hepatocellular carcinoma(HCC)who were admitted to Tianjin Third Central Hospital from January 2018 to January 2019 and underwent abdominal CT examination were selected.According to the inclusion and exclusion criteria,patients were divided into liver cirrhosis group and HCC group.NRS-2002 was used to evaluate nutritional risk,and patients were divided into nutritional risk group and non-nutritional risk group.According to Child-Pugh classification,patients with liver cirrhosis or HCC were divided into Child-Pugh A group,Child-Pugh B group and Child-Pugh C group respectively.And patients were divided into diabetic group and non-diabetic group according to whether they were combined with type 2 diabetes mellitus.Transverse diameter of the psoas muscle(TDPM)at the level of the third lumbar vertebra(L3)was measured by abdominal CT examination,and transversal psoas thickness index(TPTI)was calculated.Meanwhile,we collected related data,descriptive,comparative and correlational analyses were conducted.Results:A total of 151 patients were included in this study,including 95 patients in liver cirrhosis group and 56 patients in HCC group.Overall,patients with nutritional risk accounted for 66.9%,among which the proportions of patients with nutritional risk in Child-Pugh A,Child-Pugh B,Child-Pugh C groups in liver cirrhosis group and HCC group were 61.2%,80.6%,86.7%and 44.4%,84.6%,85.7%respectively.Among patients with liver cirrhosis,TPTI value(mm/m)was significantly lower in patients with nutritional risk than in patients without nutritional risk(13.43±3.44vs 15.50±3.16,P=0.008).Trend chi-square test was performed on the incidence of nutritional risk in patients among Child-Pugh A,Child-Pugh B and Child-Pugh C groups(?~2=5.051,P=0.025),showing that the incidence of nutritional risk was increasing as the liver function decline in cirrhotic patients.There was a negative correlation between TPTI and NRS-2002 score(r=-0.272,P=0.008).After adjusting for ALB level in Logistic regression model,the higher the TPTI value,the lower the possibility of nutritional risk in patients with liver cirrhosis(OR=0.766,95%CI=0.642-0.915).Among patients with HCC,TPTI value(mm/m)was significantly lower in patients with nutritional risk than in patients without nutritional risk(12.48±3.09 vs15.78±3.87,P=0.001).The differences in the incidence of nutritional risk among Child-Pugh A,Child-Pugh B and Child-Pugh C groups were statistically significant(P=0.014).After adjusted by Bonferroni test,there was no statistical difference in the paired comparison of the incidence of nutritional risk among the three groups;The Child-Pugh class was positively correlated with the incidence of nutritional risk(r=0.388,P=0.003),indicating that the incidence of nutritional risk increased with the decline of liver function in patients with HCC.There was a negative correlation between TPTI and NRS-2002 score(r=-0.448,P=0.001).Conclusion:TPTI is related to the nutritional risk of patients with liver cirrhosis,and the higher the TPTI value,the lower the possibility of nutritional risk.Patients with HCC at nutritional risk have lower TPTI value.With the decline of liver function,the incidence of nutritional risk in patients with liver cirrhosis or HCC has an increasing trend.