不同病因肝硬化患者L3骨骼肌指数特征及其对患者营养状况的预测价值分析

摘要 目的：探讨不同病因肝硬化患者L3骨骼肌指数特征及其对患者营养状况的预测价值分析。方法：选取2019年6月-2022年6月在我院收治的120例肝硬化患者作为研究对象，其中乙肝肝硬化40例，酒精性肝硬化40例，自身免疫性肝炎肝硬化40例。比较乙肝肝硬化组，酒精性肝硬化组，自身免疫性肝炎肝硬化L3 SMI的特征。采用Pearson相关检验分析L3 SMI与肝硬化患者营养状况的相关性。采用Logistics回归模型构建影响肝硬化营养状况的独立危险因素。采用受试者工作曲线（ROC）评估L3 SMI对肝硬化营养状况的预测价值。结果：自身免疫性肝炎肝硬化组L3 SMI、25（OH）D、ALB、PA、TRF的表达水平均显著低于酒精性肝硬化组和乙肝肝硬化组（P<0.05），且酒精性肝硬化组显著低于乙肝肝硬化组（P<0.05）。肝硬化患者LSM与25（OH）D、ALB、PA、TRF均显著正相关（P<0.05）。以肝硬化患者营养状况作为因变量（营养正常=0，营养不良=1）纳入logistics回归模型，结果显示，25（OH）DALB、PA、TRF、L3 SMI是危险因素（P<0.05）。多因素分析结果显示，25（OH）DALB、PA、TRF、L3 SMI是影响肝硬化患者营养状况的独立危险因素（P<0.05）。L3 SMI预测评估肝硬化患者营养状况的Youden指数0.765，敏感度85.00（%），特异度82.00（%），AUC值0.810，95%CI：0.685~0.912。结论：不同病因肝硬化患者L3 SMI存在明显差异，临床可采用L3 SMI对肝硬化患者营养状况做出预测评估。

Characteristics of L3 Skeletal Muscle Index and Its Predictive Value for Nutritional Status in Patients with Cirrhosis of Different Etiology

ABSTRACT Objective: To explore the characteristics of L3 skeletal muscle index in patients with cirrhosis of different etiology and its predictive value for nutritional status of patients. Methods: 120 patients with cirrhosis admitted to our hospital from June 2019 to June 2022 were selected for the study, including 40 cases of hepatitis B cirrhosis, 40 cases of alcoholic cirrhosis, and 40 cases of liver cirrhosis with autoimmune hepatitis. Compthe L3 SMI characteristics of hepatitis B cirrhosis, alcoholic cirrhosis, and autoimmune hepatitis cirrhosis. Pearson correlation test was used to analyze the correlation between L3 SMI and nutritional status in patients with cirrhosis. The independent risk factors affecting the nutritional status of cirrhosis were established by Logistics regression model. The predictive value of L3 SMI for nutritional status in cirrhosis was evaluated using receiver operating curve (ROC). Results: The expression levels of L3 SMI, 25 (OH) D, ALB, PA and TRF in autoimmune hepatitis cirrhosis group were significantly lower than those in alcoholic cirrhosis group and hepatitis B cirrhosis group (P<0.05), and alcoholic cirrhosis group was significantly lower than that in hepatitis B cirrhosis group (P<0.05). LSM was significantly positively correlated with 25 (OH) D, ALB, PA and TRF in patients with cirrhosis (P<0.05). The nutritional status of patients with cirrhosis was incorporated into logistics regression model as dependent variable (normal nutrition =0, malnutrition =1). The results showed that 25 (OH) DALB, PA, TRF and L3 SMI were risk factors (P<0.05). The results of multivariate analysis showed that 25 (OH) DALB, PA, TRF and L3 SMI were independent risk factors affecting the nutritional status of patients with cirrhosis (P<0.05). L3 SMI predicted the Youden index of 0.765, sensitivity 85.00 (%), specificity 82.00 (%), AUC value 0.810, 95%CI: 0.685~0.912. Conclusion: There are significant differences in L3 skeletal muscle index in patients with cirrhosis of different etiology, and L3 skeletal muscle index can be used in clinical prediction and evaluation of nutritional status in patients with cirrhosis.