Academic Department of Surgery, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK.
Sci Rep. 2022 Oct 5;12(1):16663. doi: 10.1038/s41598-022-20490-3.
Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The present systematic review and meta-analysis aims to examine the relationship between pre-operative CT-derived psoas and skeletal muscle parameters and outcomes in patients undergoing EVAR and F/B-EVAR for aortic aneurysm. The MEDLINE database was interrogated for studies investigating the effect of pre-operative CT-diagnosed sarcopenia on outcomes following EVAR and F/B-EVAR. The systematic review was carried out in accordance with PRISMA guidelines. The primary outcome was overall mortality. RevMan 5.4.1 was used to perform meta-analysis. PROSPERO Database Registration Number: CRD42021273085. Ten relevant studies were identified, one reporting skeletal muscle parameters, and the remaining nine reporting psoas muscle parameters, which were used for meta-analysis. There were a total of 2563 patients included (2062 EVAR, 501 F/B-EVAR), with mean follow-up ranging from 25 to 101 months. 836 patients (33%) were defined as radiologically sarcopenic. In all studies, the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 2.61 (1.67-4.08), p < .001. Two studies reported outcomes on patients undergoing F/B-EVAR; the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 3.08 (1.66-5.71), p = .004. Radiological sarcopenia defined by psoas or skeletal muscle parameters was associated with inferior survival in patients undergoing both EVAR and F/B-EVAR. Current evidence is limited by heterogeneity in assessment of body composition and lack of a consensus definition of radiological sarcopenia.
肌肉减少症的特征是骨骼肌体积和功能长期减少，并通过腰椎旁肌和骨骼肌测量进行放射学诊断。本系统评价和荟萃分析旨在研究接受腹主动脉瘤腔内修复术（EVAR）和杂交腔内修复术（F/B-EVAR）的患者术前 CT 腰椎旁肌和骨骼肌参数与结局的关系。通过 MEDLINE 数据库检索研究 EVAR 和 F/B-EVAR 后术前 CT 诊断的肌肉减少症对结局影响的研究。系统评价按照 PRISMA 指南进行。主要结局是总死亡率。RevMan 5.4.1 用于进行荟萃分析。PROSPERO 数据库注册号：CRD42021273085。确定了 10 项相关研究，其中 1 项报告了骨骼肌参数，其余 9 项报告了腰椎旁肌参数，这些参数用于荟萃分析。共纳入 2563 例患者（2062 例 EVAR，501 例 F/B-EVAR），平均随访时间为 25 至 101 个月。836 例（33%）患者被诊断为放射学肌肉减少症。在所有研究中，肌肉减少症患者与非肌肉减少症患者的全因死亡率的合并 HR 为 2.61（1.67-4.08），p<0.001。有 2 项研究报告了 F/B-EVAR 患者的结局；肌肉减少症患者与非肌肉减少症患者的全因死亡率的合并 HR 为 3.08（1.66-5.71），p=0.004。通过腰椎旁肌或骨骼肌参数定义的放射学肌肉减少症与接受 EVAR 和 F/B-EVAR 的患者的生存预后不良相关。目前的证据受到评估身体成分的异质性和缺乏放射学肌肉减少症共识定义的限制。
