王姝云,王 昀

血清中性粒细胞与淋巴细胞比值（NLR）和血清肌酐与胱抑素C比值（SCr/CysC）的联合应用在肝衰竭并发肌少症的诊断中具有重要价值。血清NLR水平是评估炎症反应的一项重要指标，其在肝衰竭患者中的升高与肌少症的发生密切相关，这可能归因于肝衰竭引发的慢性炎症影响肌肉代谢。肝衰竭和肌少症的病理生理机制复杂，但可通过血清NLR反映系统性炎症状况，从而预测肌少症发生风险。SCr/CysC比值,又叫SI指数，其临床应用研究显示该指标与肌少症诊断的相关性，且在评估肝衰竭患者肌少症风险中具有潜力。将血清NLR与SCr/CysC比值联合应用于诊断，能够提供更完善的炎症状态评估，从而提高诊断的敏感性和特异性。临床研究表明，联合诊断模型显示出更高的预测效能，为个体化治疗提供可靠依据。此外，该联合检测方法有助于改善患者预后，通过早期识别肌少症风险来指导干预措施。未来研究方向包括探索更多潜在生物标志物的联合应用，以进一步提高诊断准确性，并推动个体化治疗的进展。多中心研究与大规模临床试验将有助于验证该联合诊断策略的有效性及临床应用普及性。综上所述，血清NLR水平与SI指数的组合提供了一种有效的评估工具，有望在肝衰竭并发肌少症的早期诊断和治疗策略中发挥重要作用。

血清NLR水平；肝衰竭；肌少症；SI指数；联合诊断

[1] Utsumi M,Inagaki M,Kitada K,et al.Predictive values of sarcopenia and systemic inflammation-based markers in advanced hepatocellular carcinoma after hepatectomy.[J].Asian journal of surgery,2024. [2] Montano-Loza AJ.New concepts in liver cirrhosis:clinical significance of sarcopenia in cirrhotic patients.[J].Minerva gastroenterologica e dietologica,2013,59(2). [3] Lee HA,Yim HJ,Yeon JE,et al.Cystatin C is better than creatinine for predicting prognosis in cirrhotic patients with sarcopenia[J]. Hepatology,2016,64(1). [4] Deng Y,Sun C,wang Y,et al.THE PROGNOSTIC VALUE OF SERUM NLR FOR MORTALITY IN PATIENTS WITH HEPATOCIR- RHOSIS BASING ON PROPENSITY SCORE MATCHING[J].Gastroenterology,2019,156(6). [5] Tu X,Lin T,Huang L,et al.The diagnostic performance of Cr/CysC for sarcopenia and its predictive value on clinical outcomes in hospitalized older patients:a prospective cohort study.[J].European geriatric medicine,2024. [6] Mauro E,Crespo G,Martinez-Garmendia A,et al.Cystatin C and Sarcopenia Predict Acute on Chronic Liver Failure Development and Mortality in Patients on the Liver Transplant Waiting List.[J].Transplantation,2020,104(7). [7] 孙家镇,高静媛,盛丽春,等.中老年2型糖尿病合并肌少症与NLR等炎症标志物的相关性[J].中国骨质疏松杂志,2024,(05). [8] Nagatsu A,Maehara Y,Yoshizumi T,et al.Neutrophil lymphocyte ratio is a prognostic marker in living donor liver transplantation and correlates with sarcopenia[J].Journal of Hepato-Biliary-Pancreatic Sciences,2017,24. [9] 卢容宏,王瑜.血清NLR和PLR及MPVLR在慢性心力衰竭患者中的临床意义[J].热带医学杂志,2024,(01). [10] 刘雪纯,荆雪.肝硬化合并肌少症发病机制的研究进展[J].胃肠病学和肝病学杂志,2023,32(1). [11] Sinclair M,Gow PJ,Grossmann M,et al.Review article:sarcopenia in cirrhosis--aetiology,implications and potential therapeutic interventions.[J].Alimentary pharmacology&therapeutics,2016,43(7). [12] Kamimura H,Sato T,Natsui K,et al.Molecular Mechanisms and Treatment of Sarcopenia in Liver Disease:A Review of Current Knowledge.[J].International journal of molecular sciences,2021,22(3). [13] Dasarathy S,Merli M.Sarcopenia from mechanism to diagnosis and treatment in liver disease.[J].Journal of hepatology,2016,65(6). [14] Bruunsgaard H,Bjerregaard E,Schroll M,et al.Muscle strength after resistance training is inversely correlated with baseline levels of soluble tumor necrosis factor receptors in the oldest old.[J].Journal of the American Geriatrics Society,2004,52(2). [15] Okubo T,Atsukawa M,Tsubota A,et al.Relationship between serum vitaminD level and sarcopenia in chronic liver disease.[J]. Hepatology research:the official journal of the Japan Society of Hepatology,2020,50(5). [16] Ponziani FR,Gasbarrini A.Sarcopenia in Patients with Advanced Liver Disease.[J].Current protein&peptide science,2018,19(7). [17] Boga S,Yildirim AE,Ucbilek E,et al.The effect of sarcopenia and serum myokines on prognosis and survival in cirrhotic patients:a multicenter cross-sectional study.[J].European journal of gastroenterology&hepatology,2022,34(12). [18] Nishikawa H,Enomoto H,Yoh K,et al.Serum Zinc Concentration and Sarcopenia:A Close Linkage in Chronic Liver Diseases.[J]. Journal of clinical medicine,2019,8(3). [19] 李冬,焦连亭.肌酐和胱抑素C肾小球滤过率估算方程的应用及评价[J].国际检验医学杂志,2011,32(10):1041-1042. [20] 何瑞宽,李瑞,莫龙.CysC与Scr及sNGAL诊断肝硬化合并急性肾损伤的临床意义[J].武警后勤学院学报(医学版),2021,(3):42-44. [21] Ding P,Guo H,Sun C,et al.Serum creatinine/cystatin C ratio is a systemic marker of sarcopenia in patients with gastrointestinal stromal tumours.[J].Frontiers in nutrition,2022,9. [22] Fukushima R,Harimoto N,Okuyama T,et al.Impact of the serum creatinine and cystatin C ratio for prediction of sarcopenia and prognosis in biliary tract cancer.[J].International journal of clinical oncology,2024. [23] Shi S,Jiang Y,Chen W,et al.Diagnostic and prognostic value of the Creatinine/Cystatin C ratio for low muscle mass evaluation among US adults.[J].Frontiers in nutrition,2022,9. [24] Lin T,Jiang T,Huang X,et al.Diagnostic test accuracy of serum creatinine and cystatin C-based index for sarcopenia:a systematic review and meta-analysis.[J].Age and ageing,2024,53(1). [25] 陈汝满,白亚飞,王春莉,等.中性粒细胞/淋巴细胞比值和C反应蛋白/白蛋白比值对维持性血液透析患者全因死亡预测价值:随访5年的队列研究[J].中国全科医学,2024,(35). [26] Yang Q,Sun C,Zhao L.Expression and Predictive Value of Serum NLR,PLR Combined with SAA in Patients with Different Stages of Colorectal Cancer.[J].Frontiers in surgery,2022,9. [27] Varady NH,Schwab PE,Kheir MM,et al.Synovial Fluid and Serum Neutrophil-to-Lymphocyte Ratio:Novel Biomarkers for the Diagnosis and Prognosis of Native Septic Arthritis in Adults.[J].The Journal of bone and joint surgery.American volume,2022,104(17). [28] Yang H,Lang JH,Zhu L,et al.Diagnostic value of the neutrophil-to-lymphocyte ratio and the combination of serum CA-125 for stages III and IV endometriosis.[J].Chinese medical journal,2013,126(11). [29] 黄培坚,潘志锋,苏鸿凯.联合CRP/ALB比值和NLR对宫颈鳞状细胞癌预后的评估价值[J].转化医学杂志,2019,(2). [30] Vincent JL,Bogossian E,Menozzi M.The Future of Biomarkers.[J].Critical care clinics,2020,36(1). [31] Jens HOEFKENS.集成化数据分析在生物标志物发现及个性化医疗上具有优势[J].生命科学仪器,2011,06:10-12. [32] Ning L,Huixin H.Topic Evolution Analysis for Omics Data Integration in Cancers.[J].Frontiers in cell and developmental biology, 2021,9. [33] 医学前沿论坛暨第十五届全国肿瘤药理与临床化疗学术会议[J].中国肺癌杂志,2017,(03).

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