Chinese clinical guideline for the diagnosis and treatment of sarcopenia in liver transplant recipients

doi:10.3877/cma.j.issn.1674-3903.2024.06.004

Abstract

Abstract:

Sarcopenia is a group of systemic,progressive skeletal muscle diseases characterized by decreased muscle mass and muscle function due to a variety of etiological factors.The incidence of sarcopenia in liver transplant recipients in China exceeds 40%, which seriously restricts the efficacy of liver transplantation.To standardize and optimize the diagnosis and management of sarcopenia associated with liver transplantation, the Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association; Branch of Organ Transplant Physicians of Chinese Medical Doctor Association have organized experts to summarize and discuss the clinical diagnosis and management of sarcopenia associated with liver transplantation in China by combining the evidence-based medical basis and China's clinical practice experience, and by drawing on the relevant domestic and international literature.This guideline focuses on the diagnosis, assessment, clinical prevention and treatment of sarcopenia related to liver transplantation, and puts forward a series of recommendations in a scientific and standardized way, aiming at optimizing the perioperative and even mid-and long-term health management of liver transplantation in China.

Key words: Liver transplantation, Sarcopenia, Skeletal muscle mass, Perioperative management

Transplantation Group, Branch of Organ Transplantation of Chinese Liver, of Organ Transplant Physicians of Chinese Branch. Chinese clinical guideline for the diagnosis and treatment of sarcopenia in liver transplant recipients[J]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(06): 355-365.

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URL: https://zhyzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3903.2024.06.004

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References 107

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项目	具体描述	研究类型
证据质量分级
高(A)	非常有把握:	RCT;
	观察值接近真实值	质量升高二级的观察性研究
中(B)	对观察值有中等把握:	质量降低一级的RCT;
	观察值有可能接近真实值,但亦有可能差别很大	质量升高一级的观察性研究
低(C)	对观察值的把握有限:	质量降低二级的RCT;
	观察值可能与真实值有较大差别	观察性研究
极低(D)	对观察值几乎无把握:	质量降低三级的RCT;
	观察值与真实值可能有极大差别	质量降低一级的观察性研究;
		系列病例观察;
		个案报道
证据质量分级	推荐强度分级
强(1)	明确显示干预措施利大于弊或弊大于利
弱(2)	利弊不确定或无论质量高低的证据均显示利弊相当

项目	具体描述	研究类型
证据质量分级
高(A)	非常有把握:	RCT;
	观察值接近真实值	质量升高二级的观察性研究
中(B)	对观察值有中等把握:	质量降低一级的RCT;
	观察值有可能接近真实值,但亦有可能差别很大	质量升高一级的观察性研究
低(C)	对观察值的把握有限:	质量降低二级的RCT;
	观察值可能与真实值有较大差别	观察性研究
极低(D)	对观察值几乎无把握:	质量降低三级的RCT;
	观察值与真实值可能有极大差别	质量降低一级的观察性研究;
		系列病例观察;
		个案报道
证据质量分级	推荐强度分级
强(1)	明确显示干预措施利大于弊或弊大于利
弱(2)	利弊不确定或无论质量高低的证据均显示利弊相当

方法	优点	缺点
BIA^[12-13]	安全、经济、快速、操作简单;无辐射暴露	受体液潴留、利尿剂使用、测试前液体和食物摄入量、体力活动和BMI等影响;与CT 扫描相比,BIA 可能高估骨骼肌质量
DXA^[14-15]	安全、经济、随时可用;可重复性高;低辐射暴露	受下肢水肿影响,无法区分液体和肌肉;DXA 和CT 在识别肝硬化肌少症方面的一致性较差
超声^[16]	安全、经济、操作简单;无辐射暴露	可重复性未知;测量标准不明确
磁共振成像^[17]	无辐射暴露;可区分人体肌肉、骨骼和脂肪等组织;软组织分辨率高,信息量大	费用较贵;检查时间过长
CT^[18]	快速、准确;可区分人体肌肉、骨骼和脂肪等组织	一定辐射暴露

方法	优点	缺点
BIA^[12-13]	安全、经济、快速、操作简单;无辐射暴露	受体液潴留、利尿剂使用、测试前液体和食物摄入量、体力活动和BMI等影响;与CT 扫描相比,BIA 可能高估骨骼肌质量
DXA^[14-15]	安全、经济、随时可用;可重复性高;低辐射暴露	受下肢水肿影响,无法区分液体和肌肉;DXA 和CT 在识别肝硬化肌少症方面的一致性较差
超声^[16]	安全、经济、操作简单;无辐射暴露	可重复性未知;测量标准不明确
磁共振成像^[17]	无辐射暴露;可区分人体肌肉、骨骼和脂肪等组织;软组织分辨率高,信息量大	费用较贵;检查时间过长
CT^[18]	快速、准确;可区分人体肌肉、骨骼和脂肪等组织	一定辐射暴露

项目	临界值(AWGS2019/ JSH)
躯体功能下降(选择其中一项测试)
6 m 步行试验	<1. 0 m/ s
5 次端坐起立	≥12 s
简易躯体功能测试	≤9 分
肌肉力量下降
握力	男性<28 kg、女性<18 kg
骨骼肌质量下降(选择其中一项测试)
BIA 法	四肢骨骼肌质量指数:
	男性<7. 0 kg/ m² 、
	女性<5. 7 kg/ m²
DXA 法	四肢骨骼肌质量指数:
	男性<7. 0 kg/ m² 、
	女性<5. 4 kg/ m²
CT 法	骨骼肌指数:
	男性<42 cm² / m² 、
	女性<38 cm² / m²

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