门静脉-肝窦血管性疾病患者肌肉改变的临床特征及危险因素分析OA

Objective To investigate the prevalence of muscle changes(including sarcopenia and myosteatosis)and related influencing factors in patients with porto-sinusoidal vascular disorder(PSVD),and to provide a theoretical basis for the early identification,prevention,and intervention of muscle changes in PSVD patients.Methods A total of 132 PSVD patients who were diagnosed in Nanjing Second Hospital from July 2017 to July 2024 were enrolled as case group,and the hospital staff who underwent physical examination in 2025 were enrolled as healthy control group.Propensity score matching was performed based on age and sex at a ratio of 1∶1.According to muscle status assessed by abdominal CT,the subjects were divided into non-muscle change group,mild muscle change group(myosteatosis alone),and severe muscle change group(sarcopenia alone or sarcopenia comorbid with myosteatosis),with the type and severity of muscle change as the exposure factors.General information,laboratory tests,L3-level CT images,and liver biopsy data were collected for the patients in the case group,and general information and CT images were collected for the individuals in the healthy control group.Sarcopenia was diagnosed by measuring skeletal muscle index at the L3 level(<44.77 cm2/m2 for men and<32.50 cm2/m2 for women),and myosteatosis was defined by mean muscle attenuation combined with BMI(BMI<24.9 kg/m2 with attenuation<41 HU or BMI≥25 kg/m2 with attenuation<33 HU).Demographic,laboratory,and clinical parameters were compared between the case group and the healthy control group.The independent-samples t test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.The univariate and multivariate Logistic regression analyses were used to identify the factors associated with sarcopenia in PSVD.Results Among the 132 patients with PSVD,there were 83 patients with portal hypertension(PH)and 49 patients without PH,and there were significant differences between these two groups in age,albumin,albumin/globulin ratio,leukocyte count,neutrophil count,red blood cell count,platelet count,direct bilirubin,indirect bilirubin,hemoglobin,blood calcium,cholinesterase,total bile acid,triglyceride,total cholesterol,prothrombin time,international normalized ratio,activated partial thromboplastin time,decompensation,gastroesophageal or ectopic varices,bleeding and ascites(all P<0.05).The analyses after matching showed that compared with the healthy control group,the case group had significantly higher prevalence rates of abnormal muscle structure(43.18%vs 18.94%,P<0.001),mild muscle changes(22.73%vs 7.58%,P<0.001),and severe muscle changes(20.45%vs 11.36%,P<0.001).Further comparison showed that there was no significant difference in the proportion of patients with muscle changes between the PSVD patients with PH and those without PH(42.17%vs 44.90%,P=0.760).The binary Logistic regression analysis with the presence or absence of muscle changes as the dependent variable showed that age(odds ratio[OR]=1.05,95%confidence interval[CI]:1.02-1.09,P<0.05),subcutaneous fat index(OR=1.03,95%CI:1.01-1.06,P<0.05),hemoglobin(OR=0.97,95%CI:0.95-0.99,P<0.05),and thrombin time(OR=1.26,95%CI:1.06-1.49,P<0.05)were independent influencing factors for muscle changes in PSVD patients.The multivariate ordinal Logistic regression analysis with the severity of muscle changes as the dependent variable showed that age(OR=1.04,95%CI:1.01-1.07,P<0.05)and thrombin time(OR=1.17,95%CI:1.01-1.36,P<0.05)were independent risk factors for the grading of muscle changes.Conclusion Muscle changes are common in PSVD patients,and these changes may be caused by PSVD itself rather than PH.Age,fat distribution,thrombin time,and hemoglobin are important influencing factors for muscle changes.