Yang M, Hou S M, Yuan L, Wang M, Zheng J, Lu K Q, Yan Y, Zhang S Y, Li M, Cao J Y, Yang M, Zhang X L, Liu H, Liu B C, Wang Y, Wang B
Department of Nephrology, Affiliated Hospital of Yangzhou University, Yangzhou 225001, China.
Institute of Nephrology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China.
Zhonghua Yi Xue Za Zhi. 2023 Sep 26;103(36):2850-2858. doi: 10.3760/cma.j.cn112137-20230608-00970.
To investigate the consistency of skeletal muscle mass by CT at 1st lumbar vertebrae (L) and 3rd lumbar vertebrae (L) levels and the correlation of skeletal muscle density (SMD) at L level with prognosis in dialysis patients. A total of 1 020 patients who underwent initial dialysis and had CT examination data in four centers (Zhongda Hospital Affiliated to Southeast University, the Third Affiliated Hospital of Soochow University, Taizhou People's Hospital Affiliated to Nanjing Medical University and the Affiliated Hospital of Yangzhou University) from January 2014 to December 2019 were retrospectively collected. The skeletal muscle index (SMI) and SMD at L and L CT images were measured and calculated in patients with both L and L level CT images. The consistency of SMI and SMD at L and L levels was analyzed, and the cut-off value of SMI and SMD at L level for predicting all-cause mortality and their correlation with the prognosis of dialysis patients were studied. Cox regression model was used to analyze the risk factors for all-cause death and cardiac death. A total of 383 patients had both L and L level images, including 233 males and 150 females. The average SMD value of 16 samples (4.2%) exceeded the 95% consistency limit range (-8.71 to 7.75 HU), and the average SMI value of 15 samples (3.9%) exceeded the 95% consistency limit range (-20.45 to 9.53 HU). The optimal cut-off value of SMD at L level for predicting all-cause mortality was 36.46 HU and the area under curve (AUC) of receiver operating characteristic (ROC) curve was 0.658 (95%: 0.596-0.721, <0.001), with the sensitivity and specificity of 83.8% and 57.5%, respectively. SMI at L level was not significantly associated with all-cause mortality (=0.299). Multivariate Cox regression analysis showed that low SMD at L level was associated with all-cause mortality (=2.861, 95%: 1.576-5.193, =0.001) and cardiac death (=3.771, 95%:1.462-9.724, =0.006). SMD at L levelis consistent with SMD at L level and can be used to evaluate muscle mass. Low SMD is a risk factor for mortality in dialysis patients.
探讨第1腰椎（L1）和第3腰椎（L3）水平CT测量骨骼肌质量的一致性，以及L3水平骨骼肌密度（SMD）与透析患者预后的相关性。回顾性收集2014年1月至2019年12月在四个中心（东南大学附属中大医院、苏州大学附属第三医院、南京医科大学附属泰州人民医院和扬州大学附属医院）接受首次透析且有CT检查数据的1020例患者。对同时有L1和L3水平CT图像的患者，测量并计算L1和L3 CT图像上的骨骼肌指数（SMI）和SMD。分析L1和L3水平SMI和SMD的一致性，研究L3水平SMI和SMD预测全因死亡率的截断值及其与透析患者预后的相关性。采用Cox回归模型分析全因死亡和心源性死亡的危险因素。共有383例患者有L1和L3水平图像，其中男性233例，女性150例。16个样本（4.2%）的平均SMD值超出95%一致性限值范围（-8.71至7.75 HU），15个样本（3.9%）的平均SMI值超出95%一致性限值范围（-20.45至9.53 HU）。L3水平预测全因死亡率的SMD最佳截断值为36.46 HU，受试者工作特征（ROC）曲线下面积（AUC）为0.658（95%：0.596 - 0.721，P<0.001），敏感性和特异性分别为83.8%和57.5%。L1水平的SMI与全因死亡率无显著相关性（P = 0.299）。多因素Cox回归分析显示，L3水平低SMD与全因死亡率相关（P = 2.861，95%：1.576 - 5.193，P = 0.001）和心源性死亡相关（P = 3.771，95%：1.462 - 9.724，P = 0.006）。L3水平的SMD与L1水平的SMD一致，可用于评估肌肉质量。低SMD是透析患者死亡的危险因素。
