From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3171c, Baltimore, MD 21287 (F.P., S.D.); Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (M.S., T.Q.A.C.S., W.S.P., J.A.C.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.); Lundquist Institute at Harbor-University of California Los Angeles School of Medicine, Torrance, Calif (M.B.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); and Division of Preventive Medicine, Department of Family Medicine and Public Health, University of Calif San Diego, La Jolla, Calif (M.A.A.).
Radiology. 2021 Jun;299(3):703-711. doi: 10.1148/radiol.2021203959. Epub 2021 Apr 6.
Background Obesity and sarcopenia are associated with mortality in chronic obstructive pulmonary disease (COPD). Routine chest CT examinations may allow assessment of obesity and sarcopenia by soft-tissue markers for predicting risks of mortality. Purpose To investigate associations between soft-tissue markers subcutaneous adipose tissue (SAT), intermuscular adipose tissue (IMAT), and pectoralis muscle (PM) index from chest CT with mortality in participants with COPD. Materials and Methods In this secondary analysis of a prospectively enrolled cohort from the Multi-Ethnic Study of Atherosclerosis, participants with available chest CT in 2010-2012 were included. CT examinations were analyzed to determine SAT, IMAT (within PM), and PM areas. The spirometry evaluations were used to establish COPD diagnosis. Mortality data were extracted from the National Death Index (April 2010 to December 2017). The correlations of the soft-tissue markers with fat mass index were studied. The associations of these markers and risks of mortality in participants with COPD were assessed by using Cox proportional-hazard models adjusted for confounders. Results Among 2994 participants who were included (mean age, 69 years ± 9 [standard deviation]; 1551 women), 265 had COPD (9%; mean age, 72 years ± 9; 162 men) and 49 participants with COPD (18%) died during follow-up. The SAT, IMAT, and PM areas had moderate-to-excellent reliabilities (intraclass correlation coefficient, 0.88-0.99). In the 2994 participants, the SAT (ρ = 0.80; 95% CI: 0.78, 0.81; < .001) and IMAT indexes (ρ = 0.37; 95% CI: 0.34, 0.41; < .001) were correlated with fat mass index. Those with COPD and higher SAT index had lower risks of mortality (hazard ratio, 0.2; 95% CI: 0.1, 0.4; < .001, per doubling), whereas a higher IMAT index was associated with a higher risk of mortality (hazard ratio, 1.4; 95% CI: 1.0, 1.9; = .04, per doubling). Conclusion Soft-tissue markers were reliably obtained by using chest CT performed for lung assessment. In participants with chronic obstructive pulmonary disease, a high intermuscular adipose tissue index was associated with a higher risk of mortality than was a high subcutaneous adipose tissue index. © RSNA, 2021 See also the editorial by Sverzellati and Cademartiri in this issue.
背景 肥胖症和肌肉减少症与慢性阻塞性肺疾病（COPD）的死亡率有关。常规胸部 CT 检查可通过软组织标志物评估肥胖症和肌肉减少症，从而预测死亡率风险。目的 探讨 CT 检查中皮下脂肪组织（SAT）、肌间脂肪组织（IMAT）和胸肌（PM）指数等软组织标志物与 COPD 患者死亡率之间的相关性。材料与方法 本研究为多民族动脉粥样硬化研究前瞻性队列的二次分析，纳入了 2010-2012 年 CT 检查中可获取胸部 CT 检查结果的参与者。对 CT 检查进行分析，以确定 SAT、IMAT（位于 PM 内）和 PM 面积。使用肺量测定法评估来确定 COPD 诊断。从国家死亡索引中提取死亡率数据（2010 年 4 月至 2017 年 12 月）。研究了软组织标志物与脂肪质量指数之间的相关性。使用 Cox 比例风险模型评估了这些标志物与 COPD 患者死亡风险的相关性，模型经过混杂因素校正。结果 在纳入的 2994 名参与者中（平均年龄 69 岁 ±9[标准差]；1551 名女性），265 名参与者患有 COPD（9%；平均年龄 72 岁 ±9；162 名男性），49 名 COPD 患者（18%）在随访期间死亡。SAT、IMAT 和 PM 面积的可靠性中等至良好（组内相关系数为 0.88-0.99）。在 2994 名参与者中，SAT（ρ=0.80；95%CI：0.78，0.81；<0.001）和 IMAT 指数（ρ=0.37；95%CI：0.34，0.41；<0.001）与脂肪质量指数相关。SAT 指数较高的 COPD 患者死亡率较低（风险比，0.2；95%CI：0.1，0.4；<0.001，每增加一倍），而 IMAT 指数较高与死亡率升高相关（风险比，1.4；95%CI：1.0，1.9；=0.04，每增加一倍）。结论 采用评估肺部的胸部 CT 可可靠地获取软组织标志物。在 COPD 患者中，较高的肌间脂肪组织指数与较高的死亡率相关，而较高的皮下脂肪组织指数则与较低的死亡率相关。©RSNA，2021 本刊的 Sverzellati 和 Cademartiri 撰写的社论也讨论了这一问题。
