Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Seodaemun-gu, Korea.
Division of Geriatrics and Integrated Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
J Cachexia Sarcopenia Muscle. 2022 Apr;13(2):955-965. doi: 10.1002/jcsm.12946. Epub 2022 Feb 15.
Diagnostic cutoff points for sarcopenia in chest computed tomography (CT) have not been established although CT is widely used for investigating skeletal muscles. This study aimed to determine reference values for sarcopenia of thoracic skeletal muscles acquired from chest CT scans and to analyse variables related to sarcopenia using the cutoff values determined in a general Asian population.
We retrospectively reviewed chest CT scans of 4470 participants (mean age 54.8 ± 9.9 years, 65.8% male) performed at a check-up centre in South Korea (January 2016-August 2017). To determine cutoffs, 335 participants aged 19-39 years (mean age 35.2 ± 3.6 years, 75.2% male) were selected as the healthy and younger reference group, and 4135 participants aged ≥40 years (mean age 56.4 ± 8.4 years, 65.1% male) were selected as the study group. We measured the following: cross-sectional area (CSA) of the pectoralis, intercostalis, paraspinal, serratus, and latissimus muscles at the 4 vertebral region (T4 ); T4 divided by height (T4MI); pectoralis muscle area (PM ); and PM divided by height (PMI) at the 4 vertebral region. Sarcopenia cutoff was defined as sex-specific values of less than -2 SD below the mean from the reference group.
In the reference group, T4 , T4MI, PM , and PMI cutoffs for sarcopenia were 100.06cm , 33.69cm /m , 29.00cm , and 10.17cm /m in male, and 66.93cm , 26.01cm /m , 18.29cm , and 7.31cm /m in female, respectively. The prevalence of sarcopenia in the study group measured with T4 , T4MI, PM and PMI cutoffs were 11.4%, 8.7%, 8.5%, and 10.1%, respectively. Correlations were observed between appendicular skeletal mass divided by height measured by bioelectrical impedance analysis (BIA) and T4 (r = 0.82; P < 0.001)/T4MI (r = 0.68; P < 0.001), and ASM/height measured by BIA and PM (r = 0.72; P < 0.001)/PMI (r = 0.63; P < 0.001). In the multivariate logistic regression models, sarcopenia defined by T4 /T4MI were related to age [odds ratio (95% confidence interval), P-values: 1.09 (1.07-1.11), <0.001/1.05 (1.04-1.07), <0.001] and diabetes [1.60 (1.14-2.25), 0.007/1.47 (1.01-2.14), 0.043]. Sarcopenia defined by PM /PMI were related to age [1.09 (1.08-1.10), <0.001/1.05 (1.03-1.06), <0.001], male sex [0.23 (0.18-0.30), <0.001/0.47 (0.32-0.71), <0.001], diabetes [2.30 (1.73-3.05), <0.001/1.63 (1.15-2.32), 0.007], history of cancer [2.51 (1.78-3.55), <0.001/1.61 (1.04-2.48), 0.033], and sufficient physical activity [0.67 (0.50-0.89), 0.007/0.74 (0.56-0.99), 0.042].
The reference cutoff values of a general population reported here will enable sex-specific standardization of thoracic muscle mass quantification and sarcopenia assessment.
尽管胸部计算机断层扫描（CT）广泛用于研究骨骼肌，但目前尚未确定用于诊断肌少症的截断值。本研究旨在确定来自胸部 CT 扫描的胸骨骼肌肉减少症的参考值，并使用在一般亚洲人群中确定的截断值分析与肌肉减少症相关的变量。
我们回顾性地分析了韩国体检中心（2016 年 1 月至 2017 年 8 月）进行的 4470 名参与者（平均年龄 54.8 ± 9.9 岁，65.8%为男性）的胸部 CT 扫描。为了确定截止值，我们选择了 335 名年龄在 19-39 岁的参与者（平均年龄 35.2 ± 3.6 岁，75.2%为男性）作为健康且年轻的参考组，选择了 4135 名年龄≥40 岁的参与者（平均年龄 56.4 ± 8.4 岁，65.1%为男性）作为研究组。我们测量了以下参数：第 4 椎体（T4）处胸肌、肋间肌、脊柱旁肌、前锯肌和Latissimus 肌肉的横截面积（CSA）；T4 除以身高（T4MI）；胸肌面积（PM）；和第 4 椎体处的 PM 除以身高（PMI）。肌肉减少症的截止值定义为来自参考组的男性低于平均值-2 个标准差和女性低于平均值-1.5 个标准差的性别特异性值。
在参考组中，男性 T4、T4MI、PM 和 PMI 的肌肉减少症截断值分别为 100.06cm、33.69cm/m、29.00cm 和 10.17cm/m，女性分别为 66.93cm、26.01cm/m、18.29cm 和 7.31cm/m。使用 T4、T4MI、PM 和 PMI 截止值，研究组的肌肉减少症患病率分别为 11.4%、8.7%、8.5%和 10.1%。生物电阻抗分析（BIA）测量的四肢骨骼质量与 T4（r=0.82；P<0.001）/T4MI（r=0.68；P<0.001）呈正相关，BIA 测量的 ASM/身高与 PM（r=0.72；P<0.001）/PMI（r=0.63；P<0.001）呈正相关。在多变量逻辑回归模型中，T4/T4MI 定义的肌肉减少症与年龄[比值比（95%置信区间），P 值：1.09（1.07-1.11），<0.001/1.05（1.04-1.07），<0.001]和糖尿病[1.60（1.14-2.25），0.007/1.47（1.01-2.14），0.043]有关。PM/PMI 定义的肌肉减少症与年龄[1.09（1.08-1.10），<0.001/1.05（1.03-1.06），<0.001]、男性性别[0.23（0.18-0.30），<0.001/0.47（0.32-0.71），<0.001]、糖尿病[2.30（1.73-3.05），<0.001/1.63（1.15-2.32），0.007]、癌症病史[2.51（1.78-3.55），<0.001/1.61（1.04-2.48），0.033]和足够的身体活动[0.67（0.50-0.89），0.007/0.74（0.56-0.99），0.042]有关。
本研究报告的一般人群参考截止值将能够实现胸肌质量定量和肌肉减少症评估的性别标准化。
