Gao Haonan, Kan Xuefeng, Li Xin, Wen Yu, Sun Bo, Bai Tao, Wei Ning, Zheng Chuansheng, Song Yuhu
Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Eur J Radiol. 2024 Dec;181:111762. doi: 10.1016/j.ejrad.2024.111762. Epub 2024 Sep 25.
Partial splenic artery embolization (PSAE) is an effective procedure for cirrhotic patients with hypersplenism. The aim of our study is to evaluate the effect of PSAE on skeletal muscle, and to identify the predictor for an improvement in skeletal muscle index (SMI) in cirrhotic patients with hypersplenism after PSAE.
466 cirrhotic patients with hypersplenism underwent PASE between Dec 2013 and Mar 2022. Medical records and CT images of enrolled patients were analyzed.
105 cirrhotic patients with hypersplenism were enrolled. Sarcopenia was observed in 60.00 % (63/105) of these patients, 68.25 % (43/63) of male patients, and 31.75 % (20/63) of female patients. In cirrhotic patients, no significant change in the mean SMI at the third lumbar vertebra (L3) level after PSAE. In patients with sarcopenia, the L3 SMI increased from 36.77 cm/m (baseline) to 43.38 cm/m (P < 0.01), the L3 subcutaneous fat area (SFA) increased from 79.16 cm (baseline) to 103.52 cm (P < 0.01) at 12-month follow-up after PSAE. In patients without sarcopenia, the L3 SMI decreased from 58.38 cm/m (baseline) to 49.44 cm/m (P < 0.05), the L3 SFA increased from 89.63 cm (baseline) to 94.77 cm (P > 0.05) at 12-month follow-up after PSAE. Univariate and multivariate analysis demonstrated splenic infarction rate (OR: 0.01, P = 0.0032) and SMI (OR: 0.84, P < 0.001) were independent predictors for an improvement in skeletal muscle in patients with sarcopenia.
In cirrhotic patients with sarcopenia, an improvement in skeletal muscle and fat mass was observed after PSAE; splenic infarction rate and the L3 SMI before PSAE predicted an improvement in skeletal muscle index in patients with sarcopenia after PSAE.
部分脾动脉栓塞术（PSAE）是治疗肝硬化脾功能亢进患者的有效方法。本研究旨在评估PSAE对骨骼肌的影响，并确定肝硬化脾功能亢进患者PSAE后骨骼肌指数（SMI）改善的预测因素。
2013年12月至2022年3月期间，466例肝硬化脾功能亢进患者接受了PASE。对纳入患者的病历和CT图像进行分析。
纳入105例肝硬化脾功能亢进患者。这些患者中60.00%（63/105）存在肌肉减少症，其中男性患者占68.25%（43/63），女性患者占31.75%（20/63）。在肝硬化患者中，PSAE后第三腰椎（L3）水平的平均SMI无显著变化。在肌肉减少症患者中，PSAE后12个月随访时，L3 SMI从36.77cm/m（基线）增加到43.38cm/m（P<0.01），L3皮下脂肪面积（SFA）从79.16cm（基线）增加到103.52cm（P<0.01）。在无肌肉减少症的患者中，PSAE后12个月随访时，L3 SMI从58.38cm/m（基线）降至49.44cm/m（P<0.05），L3 SFA从89.63cm（基线）增加到94.77cm（P>0.05）。单因素和多因素分析表明，脾梗死率（OR：0.01，P=0.0032）和SMI（OR：0.84，P<0.001）是肌肉减少症患者骨骼肌改善的独立预测因素。
在肝硬化肌肉减少症患者中，PSAE后观察到骨骼肌和脂肪量有所改善；脾梗死率和PSAE前的L3 SMI可预测PSAE后肌肉减少症患者骨骼肌指数的改善。
