Division of Thoracic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Ann Thorac Surg. 2019 Jun;107(6):1626-1631. doi: 10.1016/j.athoracsur.2019.01.007. Epub 2019 Feb 2.
In lung transplantation, preoperative sarcopenia was reported to be associated with short-term outcomes based on cross-sectional image. This study aimed to investigate the influence of psoas muscle mass (PMM) on the operative outcome and survival using three-dimensional reconstruction of PMM and to evaluate the effect of preoperative sarcopenic overweight on postoperative outcomes and survival.
A total of 107 patients who underwent double lung transplantation in one institute from January 1, 2014, to June 30, 2017, were enrolled. The PMM was measured by Synapse 3D (Fujifilm, Seoul, Korea) visualization software based on computed tomography and three-dimensional reconstruction images. Patients were separated into two groups according to tercile of PMM (below the first tercile was defined as sarcopenia) and then subdivided according to PMM and overweight (body mass index ≥23 kg/m).
Sarcopenia had a significant relation with higher rate of postoperative tracheostomy (p = 0.040) and operative mortality (p = 0.023). For survival analysis, patients with sarcopenia showed a trend toward poorer outcome, but it was not significant (3-year survival rate 50.2% versus 73.2%, p = 0.054). Moreover, PMM was significantly associated with the length of mechanical ventilation (ß = -0.368, p = 0.047) and length of intensive care unit stay (ß = -0.372, p = 0.046). Sarcopenic overweight has no significant difference in terms of length of mechanical ventilation and length of intensive care unit. However, overall survival was significantly lower among patients with sarcopenic overweight than among those without sarcopenia (p = 0.026 and p = 0.024, respectively).
Sarcopenia was associated with poorer short-term outcome, and sarcopenic overweight with poorer overall survival of lung transplant patients.
在肺移植中，基于横断面图像的研究表明，术前肌少症与短期结局相关。本研究旨在通过三维重建测量腰大肌质量（PMM），探讨 PMM 对手术结局和生存的影响，并评估术前肌少症超重对术后结局和生存的影响。
本研究纳入了 2014 年 1 月 1 日至 2017 年 6 月 30 日在一家机构接受双肺移植的 107 例患者。采用 Synapse 3D（Fujifilm，韩国首尔）可视化软件基于 CT 及三维重建图像测量 PMM。根据 PMM 的三分位数（低于第一分位数定义为肌少症）将患者分为两组，然后根据 PMM 和超重（体重指数≥23 kg/m）进一步分组。
肌少症与术后气管切开术（p=0.040）和手术死亡率（p=0.023）的发生率升高显著相关。生存分析显示，肌少症患者的生存结果有较差的趋势，但无统计学意义（3 年生存率 50.2%对 73.2%，p=0.054）。此外，PMM 与机械通气时间（ß=-0.368，p=0.047）和 ICU 住院时间（ß=-0.372，p=0.046）显著相关。肌少症超重患者在机械通气时间和 ICU 住院时间方面没有显著差异。然而，与非肌少症患者相比，肌少症超重患者的总生存明显降低（分别为 p=0.026 和 p=0.024）。
肌少症与肺移植患者的短期结局较差相关，肌少症超重与总生存较差相关。
