肝移植候选者的肌肉功能、质量和品质比较：肝移植研究功能评估结果
A Comparison of Muscle Function, Mass, and Quality in Liver Transplant Candidates: Results From the Functional Assessment in Liver Transplantation Study.
作者信息
Wang Connie W, Feng Sandy, Covinsky Kenneth E, Hayssen Hilary, Zhou Li-Qin, Yeh Benjamin M, Lai Jennifer C
机构信息
1 Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, San Francisco, CA.2 Division of Transplant Surgery, Department of Surgery, University of California-San Francisco, San Francisco, CA.3 Division of Geriatrics, Department of Medicine, University of California-San Francisco, San Francisco, CA.4 Department of Radiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China.5 Division of Abdominal Imaging, Department of Radiology, University of California-San Francisco, San Francisco, CA.
出版信息
Transplantation. 2016 Aug;100(8):1692-8. doi: 10.1097/TP.0000000000001232.
BACKGROUND
Sarcopenia and functional impairment are common and lethal extrahepatic manifestations of cirrhosis. We aimed to determine the association between computed tomography (CT)-based measures of muscle mass and quality (sarcopenia) and performance-based measures of muscle function.
METHODS
Adults listed for liver transplant underwent testing of muscle function (grip strength, Short Physical Performance Battery [SPPB]) within 3 months of abdominal CT. Muscle mass (cm/m) = total cross-sectional area of psoas, paraspinal, and abdominal wall muscles at L3 on CT, normalized for height. Muscle quality = mean Hounsfield units for total skeletal muscle area at L3.
RESULTS
Among 292 candidates, median grip strength was 31 kg, SPPB score was 11, muscle mass was 49 cm/m, and muscle quality was 35 Hounsfield units. Grip strength weakly correlated with muscle mass (ρ = 0.26, P < 0.001) and quality (ρ = 0.27, P < 0.001) in men, and muscle quality (ρ = 0.23, P = 0.02), but not muscle mass, in women. Short Physical Performance Battery correlated weakly with muscle quality in men (ρ = 0.38, P < 0.001) and women (ρ = 0.25, P = 0.02), however, did not correlate with muscle mass in men or women. After adjustment for sex, model for end-stage liver disease (MELD)-Na, hepatocellular carcinoma, and body mass index, grip strength (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.59-0.92; P = 0.008), SPPB (HR, 0.89; 95% CI, 0.82-0.97; P = 0.01), and muscle quality (HR, 0.77; 95% CI, 0.63-0.95; P = 0.02) were associated with waitlist mortality, but muscle mass was not (HR, 0.91; 95% CI, 0.75-1.11; P = 0.35).
CONCLUSIONS
Performance-based tests of muscle function are only modestly associated with CT-based muscle measures. Given that they predict waitlist mortality and can be conducted quickly and economically, tests of muscle function may have greater clinical utility than CT-based measures of sarcopenia.
背景
肌肉减少症和功能障碍是肝硬化常见且致命的肝外表现。我们旨在确定基于计算机断层扫描（CT）的肌肉质量和质量（肌肉减少症）测量与基于表现的肌肉功能测量之间的关联。
方法
列入肝移植名单的成年人在腹部CT检查后3个月内接受肌肉功能测试（握力、简短身体功能测试[SPPB]）。肌肉质量（cm/m）=CT上L3水平腰大肌、椎旁肌和腹壁肌肉的总横截面积，按身高进行标准化。肌肉质量= L3水平总骨骼肌面积的平均亨氏单位。
结果
在292名候选人中，握力中位数为31kg，SPPB评分为11分，肌肉质量为49cm/m，肌肉质量为35亨氏单位。男性中，握力与肌肉质量（ρ = 0.26，P < 0.001）和质量（ρ = 0.27，P < 0.001）弱相关，女性中握力与肌肉质量（ρ = 0.23，P = 0.02），而非肌肉质量弱相关。简短身体功能测试在男性（ρ = 0.38，P < 0.001）和女性（ρ = 0.25，P = 0.02）中与肌肉质量弱相关，然而，在男性或女性中与肌肉质量均无相关性。在对性别、终末期肝病模型（MELD）-钠、肝细胞癌和体重指数进行调整后，握力（风险比[HR]，0.74；95%置信区间[95%CI]，0.59 - 0.92；P = 0.008）、SPPB（HR，0.89；95%CI，0.82 - 0.97；P = 0.01）和肌肉质量（HR，0.77；95%CI，0.63 - 0.95；P = 0.02）与等待名单死亡率相关，但肌肉质量与等待名单死亡率无关（HR，0.91；95%CI，0.75 - 1.11；P = 0.35）。
结论
基于表现的肌肉功能测试与基于CT的肌肉测量仅适度相关。鉴于它们可预测等待名单死亡率，且能快速且经济地进行，肌肉功能测试可能比基于CT的肌肉减少症测量具有更大的临床实用性。
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