2026 年第 5 期 第 21 卷

肝硬化患者血清胰岛素样生长因子结合蛋白1和血管生成素样蛋白4水平与肌少症的关系及对其预测价值分析

Analysis of the relationship between serum insulin-like growth factor binding protein-1 and angiopoietin-like protein 4 levels and sarcopenia in patients with liver cirrhosis and their predictive value

作者：李宁霍泽民周琪臻康慧娟吕晶于慧张丽

英文作者：Li Ning Huo Zemin Zhou Qizhen Kang Huijuan Lyu Jing Yu Hui Zhang Li

单位：北京大学第一医院太原医院（太原市中心医院）消化科，太原030024

英文单位：Department of Gastroenterology Taiyuan Hospital Peking University First Hospital (Taiyuan Central Hospital) Taiyuan 030024 China

关键词：肝硬化；胰岛素样生长因子结合蛋白1；血管生成素样蛋白4；肌少症

英文关键词：Livercirrhosis;Insulin-likegrowthfactorbindingprotein-1;Angiopoietin-likeprotein4;Sarcopenia

• 摘要：

• 目的 探讨肝硬化患者血清胰岛素样生长因子结合蛋白1（IGFBP-1）、血管生成素样蛋白4（ANGPTL-4）水平与肌少症的关系及对其预测价值。方法 选取2023年1月至2025年7月太原市中心医院消化科收治的肝硬化患者167例（肝硬化组）及同期健康体检志愿者167例（对照组），采用酶联免疫吸附法检测血清IGFBP-1、ANGPTL-4水平。根据是否并发肌少症将肝硬化患者分为肌少症组和非肌少症组，分析肝硬化患者并发肌少症的因素及血清IGFBP-1、ANGPTL-4水平对肌少症的预测价值。结果 肝硬化组血清IGFBP-1水平高于对照组，ANGPTL-4水平低于对照组［（30±5）μg/L比（16±4）μg/L、（27±5）μg/L比（40±5）μg/L］（均P＜0.001）。肝硬化患者血清IGFBP-1水平与四肢骨骼肌质量指数、握力、6 m步速均呈负相关，与5次坐起时间呈正相关，而ANGPTL-4水平与以上指标的相关性和IGFBP-1恰恰相反（均P＜0.001）。多因素Logistic回归分析结果 显示，年龄增加、肝功能Child-Pugh分级C级、IGFBP-1升高为肝硬化患者并发肌少症的独立危险因素，体重指数增加、ANGPTL-4升高为独立保护因素（均P＜0.05）。血清IGFBP-1、ANGPTL-4水平及二者联合预测肝硬化患者并发肌少症的曲线下面积分别为0.803、0.794、0.877，二者联合预测肝硬化患者并发肌少症的曲线下面积大于血清IGFBP-1、ANGPTL-4水平单独预测（均P＜0.05）。结论 肝硬化患者血清IGFBP-1水平升高和ANGPTL-4水平降低与并发肌少症有关，血清IGFBP-1、ANGPTL-4水平联合预测肌少症的价值较高。

• Objective To investigate the relationship between serum insulin-like growth factor binding protein-1 (IGFBP-1) and angiopoietin-like protein 4 (ANGPTL-4) levels and sarcopenia in patients with liver cirrhosis, and their predictive value. Methods A total of 167 patients with liver cirrhosis admitted to the Department of Gastroenterology, Taiyuan Central Hospital, from January 2023 to July 2025 (cirrhosis group) and 167 healthy volunteers (control group) during the same period were enrolled. Serum levels of IGFBP-1 and ANGPTL-4 were detected by enzyme-linked immunosorbent assay. According to the presence or absence of sarcopenia, patients with liver cirrhosis were divided into sarcopenia group and non-sarcopenia group. The factors associated with sarcopenia in cirrhotic patients and the predictive value of serum IGFBP-1 and ANGPTL-4 levels for sarcopenia were analyzed. Results Serum IGFBP-1 level was higher and ANGPTL-4 level was lower in the cirrhosis group than those in the control group ［(30±5)μg/L vs (16±4)μg/L, (27±5)μg/L vs (40±5)μg/L］(both P<0.001). In cirrhotic patients, serum IGFBP-1 level was negatively correlated with appendicular skeletal muscle mass index, handgrip strength and 6-meter walking speed, and positively correlated with 5-time sit-up time, while the correlations of ANGPTL-4 level with the above indicators were opposite to those of IGFBP-1 (all P<0.001). Multivariate Logistic regression analysis showed that increased age, Child-Pugh class C liver function and elevated IGFBP-1 were independent risk factors for sarcopenia in cirrhotic patients, while increased body mass index and elevated ANGPTL-4 were independent protective factors (all P<0.05). The areas under the curve of serum IGFBP-1, ANGPTL-4 and their combination for predicting sarcopenia in cirrhotic patients were 0.803, 0.794 and 0.877, respectively. The area under the curve of the combined prediction was larger than that of single prediction (all P<0.001). Conclusion Elevated serum IGFBP-1 and decreased ANGPTL-4 are associated with sarcopenia in cirrhotic patients. The combination of serum IGFBP-1 and ANGPTL-4 has high predictive value for sarcopenia.