Heard Rachel, Black Douglas, Ramsay George, Scott Neil, Hildebrand Diane
Department of General Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK.
Surgeon. 2018 Dec;16(6):325-332. doi: 10.1016/j.surge.2018.03.001. Epub 2018 Apr 16.
Sarcopaenia, loss of lean muscle mass and quality, has prognostic significance and can be used to guide the management of oncology patients. However, there is limited research into the prevalence and effect of sarcopaenia in vascular populations. We aim to investigate the prevalence of this measure of physiological reserve in a vascular patient group.
All patients admitted to a tertiary vascular unit in a single year were considered for the study. Patients with an abdominal CT scan (available for analysis) within 12 months of admission were included. Patient data were extracted from electronic patient records and hospital case notes. CT scans were analysed at L3 vertebral body to calculate body composition indices, as previously described. Sarcopaenia was defined as skeletal muscle index of <41 cm/m in female patients and non-obese males and <53 cm/m in obese males. Outcome at 3-years was ascertained.
Of 314 patients, 129 (41.1%) were sarcopaenic. Female patients were more likely to be sarcopaenic (p < 0.0001). The prevalence of sarcopaenia increased with age (p < 0.001). Rates of sarcopaenia didn't differ between occlusive and aneurysmal diagnoses. In a potentially unique finding in vascular literature to date, mortality and non-home discharge were not significantly different between the groups. On multivariate analysis, sarcopaenia was not significantly associated with earlier death (p = 0.55).
Sarcopaenia is highly prevalent in vascular surgical patients. In our analysis, sarcopaenia was not independently associated with mortality. Potentially the associated cardiovascular risk of patients with end stage vascular disease may negate the additional risk of altered body composition.
肌肉减少症，即瘦肌肉量和质量的丧失，具有预后意义，可用于指导肿瘤患者的管理。然而，关于血管疾病人群中肌肉减少症的患病率和影响的研究有限。我们旨在调查血管疾病患者群体中这种生理储备指标的患病率。
研究纳入了某一年入住三级血管病科的所有患者。纳入入院12个月内进行过腹部CT扫描（可供分析）的患者。从电子病历和医院病例记录中提取患者数据。如前所述，在L3椎体水平分析CT扫描图像以计算身体成分指数。肌肉减少症的定义为：女性患者和非肥胖男性的骨骼肌指数<41 cm/m，肥胖男性的骨骼肌指数<53 cm/m。确定3年时的结局。
314例患者中，129例（41.1%）存在肌肉减少症。女性患者更易出现肌肉减少症（p<0.0001）。肌肉减少症的患病率随年龄增加而升高（p<0.001）。闭塞性疾病和动脉瘤性疾病患者的肌肉减少症发生率无差异。在血管疾病文献中，这一发现可能较为独特，两组患者的死亡率和非回家出院率无显著差异。多因素分析显示，肌肉减少症与早期死亡无显著相关性（p = 0.55）。
肌肉减少症在血管外科患者中非常普遍。在我们的分析中，肌肉减少症与死亡率无独立相关性。终末期血管疾病患者潜在的心血管风险可能抵消了身体成分改变带来的额外风险。
