基于计算机断层扫描的腹膜透析患者肌肉减少症：与瘦体软组织的相关性及其与生存的关系。
Computed tomography-based sarcopenia in patients receiving peritoneal dialysis: Correlation with lean soft tissue and survival.
机构信息
Departments of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Departments of Internal Medicine, National Taiwan University Hospital Beihu Branch and College of Medicine, National Taiwan University, Taipei, Taiwan.
出版信息
J Formos Med Assoc. 2022 Feb;121(2):500-509. doi: 10.1016/j.jfma.2021.06.026. Epub 2021 Jul 14.
BACKGROUND/PURPOSE: We evaluated whether the results of the computed tomography (CT)-based sarcopenia assessment were correlated with edema-free lean soft tissue (LST) and were associated with the prognosis of patients receiving peritoneal dialysis (PD).
METHODS
We conducted a prospective cohort study and enrolled patients aged >20 years who started to undergo PD between February 2009 and February 2012. All patients underwent LST evaluation and non-contrast abdominal CT for assessing the total skeletal muscle (TSM) and psoas muscle (PM) indices at the level of the third lumbar vertebra. We analyzed the correlation between LST and CT assessment of muscle mass. Then we determined optimal sex-specific cutoff values for TSM-defined and PM-defined sarcopenia to predict mortality, aided by the maximally selected rank statistics.
RESULTS
A total of 158 patients were enrolled, of whom 41 (25.9%) and 65 (41.1%) had sarcopenia based on the TSM and PM indices, respectively. LST was significantly strong correlated with TSM and PM indices (r = 0.517, p < 0.001 and r = 0.688, p < 0.001, respectively). In univariate and multivariate analyses after adjusting clinical and PD-related parameters, only patients with PM-defined sarcopenia had poorer survival than did those without (hazard ratio [HR]: 2.386, 95% confidence interval [CI]: 1.315-4.330), but patients with TSM-defined sarcopenia did not show a poorer survival (HR: 1.608, 95% CI: 0.860-3.006).
CONCLUSION
Sarcopenia assessment based on CT was strongly correlated with LST and PM-defined sarcopenia indicated poor prognosis in patients receiving long-term PD.
背景/目的：我们评估了基于计算机断层扫描（CT）的肌肉减少症评估结果是否与去水肿后瘦软组织（LST）相关，并与接受腹膜透析（PD）的患者的预后相关。
方法
我们进行了一项前瞻性队列研究，纳入了 20 岁以上于 2009 年 2 月至 2012 年 2 月期间开始接受 PD 的患者。所有患者均进行了 LST 评估和非对比腹部 CT，以评估第三腰椎水平的总骨骼肌（TSM）和腰大肌（PM）指数。我们分析了 LST 与 CT 评估肌肉质量之间的相关性。然后，我们确定了 TSM 定义和 PM 定义的肌肉减少症的最佳性别特异性截断值，以通过最大选择秩统计来预测死亡率。
结果
共纳入 158 例患者，其中 41 例（25.9%）和 65 例（41.1%）根据 TSM 和 PM 指数分别存在肌肉减少症。LST 与 TSM 和 PM 指数显著相关（r=0.517，p<0.001 和 r=0.688，p<0.001）。在调整临床和 PD 相关参数后的单因素和多因素分析中，仅 PM 定义的肌肉减少症患者的生存率低于无肌肉减少症患者（风险比[HR]：2.386，95%置信区间[CI]：1.315-4.330），而 TSM 定义的肌肉减少症患者的生存率没有较差（HR：1.608，95% CI：0.860-3.006）。
结论
基于 CT 的肌肉减少症评估与 LST 和 PM 定义的肌肉减少症密切相关，接受长期 PD 的患者中 PM 定义的肌肉减少症表明预后不良。
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