一种简单的肌少症检测方法可预测腹型肥胖患者的不良心血管事件。

A simple method of sarcopenia detection can predict adverse cardiovascular events in patients with abdominal obesity.

机构信息

Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.

Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.

出版信息

Int J Obes (Lond). 2021 Oct;45(10):2214-2220. doi: 10.1038/s41366-021-00895-2. Epub 2021 Jul 3.

DOI:10.1038/s41366-021-00895-2

PMID:34218263

Abstract

BACKGROUND

Although sarcopenic obesity is associated with a higher risk of cardiovascular events compared with obesity without sarcopenia, it is difficult to diagnose sarcopenia in daily clinical settings. Recently, a simple scoring system has been developed to identify sarcopenia patients based on three variables (age, hand grip strength, and calf circumference). However, the utility of this score for cardiovascular risk stratification in patients with abdominal obesity is unknown.

METHODS

We calculated the sarcopenia score in 262 patients with abdominal obesity, defined as a waist circumference ≥90 cm in women or ≥85 cm in men. The composite endpoint of this study was cardiovascular mortality, nonfatal myocardial infarction, stroke, unstable angina, and heart failure hospitalization.

RESULTS

Of the 262 patients, 108 had a high sarcopenia score based on previously established criteria (≥105 in men and ≥120 in women). The patients with a high sarcopenia score had a significantly higher plasma level of B-type natriuretic peptide compared with those with a low sarcopenia score (median 56.7, interquartile range [28.2-142.9] vs. 37.9 [13.8-76.1] pg/mL; p < 0.0001). Kaplan-Meier curves revealed a significantly lower event-free survival rate in those with a high compared with a low sarcopenia score (log-rank test p = 0.001), even after adjustment for confounding factors using propensity score matching (log-rank test p = 0.009). Multivariate Cox proportional hazard analysis identified a high sarcopenia score (hazard ratio: 2.46; 95% confidence interval: 1.31-4.64, p = 0.005) as an independent predictor of the primary endpoints. The combination of a high sarcopenia score and low body mass index (<25 kg/m) predicted a significantly higher risk of future adverse events (p = 0.005). Furthermore, patients with a high sarcopenia score and high B-type natriuretic peptide level (≥200 pg/mL) had the poorest prognosis (p < 0.0001).

CONCLUSIONS

This simple screening test for sarcopenia can predict future adverse cardiovascular events in patients with abdominal obesity.

摘要

背景

与非肌少症肥胖相比，肌少症合并肥胖与心血管事件风险增加相关，但在日常临床环境中很难诊断肌少症。最近，已经开发出一种简单的评分系统，该系统基于三个变量（年龄、握力和小腿围）来识别肌少症患者。然而，该评分系统在有腹型肥胖的患者中用于心血管风险分层的效用尚不清楚。

方法

我们计算了 262 例腹型肥胖患者的肌少症评分，腹型肥胖定义为女性腰围≥90cm 或男性腰围≥85cm。本研究的复合终点为心血管死亡率、非致死性心肌梗死、卒中和不稳定型心绞痛以及心力衰竭住院。

结果

在 262 例患者中，根据先前建立的标准，有 108 例患者具有高肌少症评分（男性≥105 分，女性≥120 分）。与低肌少症评分患者相比，高肌少症评分患者的 B 型利钠肽（BNP）血浆水平显著升高（中位数 56.7，四分位距[28.2-142.9] vs. 37.9[13.8-76.1]pg/ml；p<0.0001）。Kaplan-Meier 曲线显示，高肌少症评分患者的无事件生存率显著低于低肌少症评分患者（对数秩检验 p=0.001），即使在使用倾向评分匹配对混杂因素进行调整后（对数秩检验 p=0.009）。多变量 Cox 比例风险分析确定高肌少症评分（危险比：2.46；95%置信区间：1.31-4.64，p=0.005）是主要终点的独立预测因子。高肌少症评分和低体质指数（<25kg/m）的组合预测未来不良事件的风险显著增加（p=0.005）。此外，高肌少症评分和高 B 型利钠肽水平（≥200pg/ml）的患者预后最差（p<0.0001）。