Department of Medicine, Gyeongsang National University College of Medicine, Jinju, Gyeongsangnam-do, South Korea.
Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, South Korea.
Medicine (Baltimore). 2024 May 31;103(22):e38284. doi: 10.1097/MD.0000000000038284.
Sarcopenia is a contributing factor in the development of long-COVID syndrome. We aimed to investigate how intercostal muscle mass changes over 3 months compared to other chest wall muscles following COVID-19 infection, along with identifying factors contributing to intercostal muscle loss during follow-up. We retrospectively studied 110 COVID-19 patients, analyzing muscle masses in the intercostal, pectoralis, and thoracic 12th vertebra level (T12) on initial and follow-up CT scans. Muscle mass was quantitatively assessed using density histogram analysis. We calculated the muscle difference ratio (MDR) as the following formula: (initial muscle mass - follow-up muscle mass)/initial muscle mass. Patients were categorized into 2 groups: <3 months follow-up (n = 53) and ≥ 3 months follow-up (n = 57). We employed stepwise logistic regression, using intercostal MDR ≥ 25% in follow-up as an independent variable and age < 65 years, ventilator use, steroid use, follow-up > 3 months, hospital stay > 13 days, body mass index < 18.5 kg/m², and female gender as dependent variables. The loss of intercostal muscle was the most severe among the 3 chest wall muscles in the CT follow-up. Intercostal MDR was significantly higher in the ≥ 3 months follow-up group compared to the < 3 months group (32.5 ± 23.6% vs 19.0 ± 21.1%, P = .002). There were no significant differences in pectoralis MDR or T12 MDR between the 2 groups. Stepwise logistic regression identified steroid use (3.494 (1.419-8.604), P = .007) and a follow-up period > 3 months [3.006 (1.339-6.748), P = .008] as predictors of intercostal MDR ≥ 25%. The intercostal muscle wasting was profound compared to that in the pectoralis and T12 skeletal muscles in a follow-up CT scan, and the intercostal muscle wasting was further aggravated after 3 months of COVID-19 infection. The use of steroids and a follow-up period exceeding 3 months were significant predictors for ≥ 25% of intercostal muscle wasting in follow-up.
肌肉减少症是长新冠综合征发展的一个促成因素。我们旨在研究与 COVID-19 感染后其他胸壁肌肉相比，肋间肌的质量在 3 个月内的变化情况，以及确定在随访过程中导致肋间肌损失的因素。我们回顾性地研究了 110 例 COVID-19 患者，在初始和随访 CT 扫描上分析肋间肌、胸肌和第 12 胸椎水平（T12）的肌肉质量。使用密度直方图分析对肌肉质量进行定量评估。我们计算了肌肉差异比（MDR），公式如下：（初始肌肉质量-随访肌肉质量）/初始肌肉质量。患者分为 2 组：随访<3 个月（n=53）和随访≥3 个月（n=57）。我们采用逐步逻辑回归，将随访时肋间肌 MDR≥25%作为自变量，年龄<65 岁、使用呼吸机、使用类固醇、随访>3 个月、住院时间>13 天、体重指数<18.5kg/m²和女性作为因变量。在 CT 随访中，肋间肌是 3 个胸壁肌肉中损失最严重的。与随访<3 个月组相比，随访≥3 个月组的肋间肌 MDR 显著更高（32.5%±23.6%比 19.0%±21.1%，P=0.002）。两组间胸肌 MDR 或 T12 MDR 无显著差异。逐步逻辑回归确定使用类固醇（3.494（1.419-8.604），P=0.007）和随访期>3 个月[3.006（1.339-6.748），P=0.008]是肋间肌 MDR≥25%的预测因素。与 CT 随访中的胸肌和 T12 骨骼肌相比，肋间肌在随访中的萎缩程度更为严重，并且 COVID-19 感染后 3 个月，肋间肌的萎缩进一步加重。使用类固醇和随访时间超过 3 个月是随访中肋间肌损失≥25%的显著预测因素。
