Ikeno Yuki, Koide Yutaka, Abe Noriyuki, Matsueda Takashi, Izawa Naoto, Yamazato Takahiro, Miyahara Shunsuke, Nomura Yoshikatsu, Sato Shunsuke, Takahashi Hiroaki, Inoue Takeshi, Matsumori Masamichi, Tanaka Hiroshi, Ishihara Satoshi, Nakayama Shinichi, Sugimoto Koji, Okita Yutaka
Division of Cardiovascular Surgery, Kobe University, Kobe, Japan.
Division of Radiology, Kobe University, Kobe, Japan.
Eur J Cardiothorac Surg. 2017 Jun 1;51(6):1135-1141. doi: 10.1093/ejcts/ezx050.
The purpose of this study was to identify the cut-off value of sarcopenia based on the psoas muscle area index and evaluate early and late outcomes following elective total arch replacement in the elderly.
Sarcopenia was assessed by the psoas muscle area index [defined as the psoas muscle area at the L3 level on computed tomography (cm 2 )/body surface area (m 2 )]. The cut-off value for sarcopenia was defined as > 2 standard deviations below the mean psoas muscle area index value obtained from 464 normal control patients. Between October 1999 and July 2015, 266 patients who were ≥ 65 years and had undergone psoas muscle area index measurement underwent elective total arch replacement. These patients were classified into the sarcopenia (Group S, n = 81) and non-sarcopenia (Group N, n = 185) groups.
The mean age was 76.2 ± 5.6 years in Group S and 75.7 ± 5.7 years in Group N ( P = 0.553). Hospital mortality was 3.7% (3/81) in Group S and 2.2% (4/185) in Group N ( P = 0.483). Mean follow-up was 48.3 ± 38.7 months. Five-year survival was significantly worse in Group S (S: 63.2 ± 6.6% vs N: 88.7 ± 2.6%, P < 0.001). A multivariable Cox proportional hazard analysis showed that sarcopenia significantly predicted poor survival (hazard ratio 2.59; 95% confidence interval 1.27-5.29; P = 0.011).
Sarcopenia did not predict hospital death following total arch replacement, but it was negatively associated with overall survival. Sarcopenia can be an additional risk factor to estimate the outcomes of thoracic aortic surgery.
本研究旨在确定基于腰大肌面积指数的肌肉减少症的临界值，并评估老年患者择期全弓置换术后的早期和晚期结局。
通过腰大肌面积指数评估肌肉减少症[定义为计算机断层扫描（CT）上L3水平的腰大肌面积（cm²）/体表面积（m²）]。肌肉减少症的临界值定义为低于从464名正常对照患者获得的平均腰大肌面积指数值2个标准差以上。1999年10月至2015年7月，266例年龄≥65岁且已进行腰大肌面积指数测量的患者接受了择期全弓置换术。这些患者被分为肌肉减少症组（S组，n = 81）和非肌肉减少症组（N组，n = 185）。
S组的平均年龄为76.2±5.6岁，N组为75.7±5.7岁（P = 0.553）。S组的医院死亡率为3.7%（3/81），N组为2.2%（4/185）（P = 0.483）。平均随访时间为48.3±38.7个月。S组的5年生存率明显较差（S组：63.2±6.6% vs N组：88.7±2.6%，P < 0.001）。多变量Cox比例风险分析显示，肌肉减少症显著预测生存率较差（风险比2.59；95%置信区间1.27 - 5.29；P = 0.011）。
肌肉减少症不能预测全弓置换术后的医院死亡，但与总体生存率呈负相关。肌肉减少症可作为评估胸主动脉手术结局的一个额外风险因素。
