Dept. of Medicine, University of Toronto, Canada; Respirology, Lung Transplant Program, University Health Network, Canada.
Clinical Research Centre, Hospital de Base do Distrito Federal, Brasilia, Brazil.
Respir Med. 2017 Oct;131:125-134. doi: 10.1016/j.rmed.2017.08.007. Epub 2017 Aug 11.
Non-invasive imaging modalities allow for detailed assessment of peripheral skeletal muscle wasting, which is associated with increased morbidity and mortality in chronic lung disease. Given the increased utilization of imaging tools, a systematic review was conducted using PRISMA guidelines to describe the modalities and acquisition techniques used to evaluate skeletal muscle in chronic lung disease and assess the relationships of muscle size and composition with strength, physical performance, structural alterations and clinical outcomes.
Six electronic databases were searched (inception-May 2017) to identify prospective studies measuring peripheral skeletal muscle size or composition using computed tomography (CT), magnetic resonance imaging/spectroscopy (MRI/MRS), or ultrasound (US) in adult chronic lung disease patients.
Fifty-eight articles were included, which utilized: CT (n = 26), MRI/MRS (n = 16) and US (n = 16) in 2254 participants. All studies measured muscle size, predominantly of the lower extremity (n = 53), and only nine assessed muscle composition (i.e. fat infiltration) mainly with CT or MRI/MRS (n = 7). Thigh muscle size had a significant association with strength (r = 0.43-0.83, n = 13/14 studies), 6-min walk distance (r = 0.60-0.62, n = 3/6) and physical activity (r = 0.30-0.82, n = 3). Thigh muscle atrophy was independently associated with increased re-hospitalization (n = 1) and mortality (n = 3). Increased muscle fat infiltration had a moderate association with reduced physical performance partly related to increased anaerobic metabolism, but its prognostic utility was not assessed.
Imaging modalities are valuable tools for the characterization of skeletal muscle dysfunction in chronic lung disease in clinical and research settings. The use of muscle imaging as a prognostic marker is promising and requires further study.
无创成像技术可对周围骨骼肌萎缩进行详细评估，而后者与慢性肺部疾病患者的发病率和死亡率增加相关。鉴于影像学工具的应用日益广泛，本研究采用 PRISMA 指南进行了系统评价，旨在描述用于评估慢性肺部疾病患者骨骼肌的影像学方法和采集技术，并评估肌肉大小和组成与力量、身体机能、结构改变和临床结局的相关性。
检索了 6 个电子数据库（从建库到 2017 年 5 月），以确定前瞻性研究，这些研究使用计算机断层扫描（CT）、磁共振成像/光谱（MRI/MRS）或超声（US）评估了成年慢性肺部疾病患者的周围骨骼肌大小或组成。
共纳入 58 篇文章，涉及 2254 名患者，使用 CT（n=26）、MRI/MRS（n=16）和 US（n=16）。所有研究均测量了肌肉大小，主要是下肢（n=53），仅有 9 项研究（n=7）评估了肌肉组成（即脂肪浸润），主要采用 CT 或 MRI/MRS。大腿肌肉大小与力量（r=0.43-0.83，n=13/14 项研究）、6 分钟步行距离（r=0.60-0.62，n=3/6）和身体活动（r=0.30-0.82，n=3）显著相关。大腿肌肉萎缩与再住院（n=1）和死亡（n=3）的风险增加独立相关。肌肉脂肪浸润增加与身体机能下降具有中等相关性，这部分与无氧代谢增加有关，但尚未评估其预后预测价值。
影像学方法是在临床和研究环境中对慢性肺部疾病患者骨骼肌功能障碍进行特征描述的有价值的工具。将肌肉影像学作为一种预后标志物具有广阔的应用前景，值得进一步研究。
