Mirzai Saeid, Bancks Michael P, Brinkley Tina E, Carbone Salvatore, Tang W H Wilson, Allison Matthew A, Shapiro Michael D
Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Clin Nutr. 2025 Feb;45:61-65. doi: 10.1016/j.clnu.2024.12.026. Epub 2024 Dec 25.
BACKGROUND & AIMS: Skeletal muscle (SM) health has significant prognostic value in geriatric and chronic disease populations, yet its assessment is frequently omitted due to challenges in evaluation. The creatinine-to-cystatin C ratio (CCR) is a simple serum-based measure that associates well with measured SM quantity (myopenia) and strength, but evidence for its association with SM quality (myosteatosis) is limited and conflicting. This study investigated the association between CCR and computed tomography (CT) measures of myopenia and myosteatosis.
In this cross-sectional analysis of the Multi-Ethnic Study of Atherosclerosis, 1035 participants with complete body composition measurements and visit-matched serum creatinine and cystatin C measurements were included. CCR was calculated as (serum creatinine/serum cystatin C) x 100. Myopenia was quantified as SM index (SMI; SM area normalized for body surface area) and myosteatosis as SM density (SMD; based on Hounsfield units) from CT images. Correlation analyses and multivariable linear regression were used to model the relationships of CCR with SMI and SMD.
CCR was positively correlated and associated with SMI (rho = 0.295, p < 0.001; adjusted β 0.071 per 1 % increase in CCR, standard error [SE] 0.032, 95 % confidence interval [CI] 0.009 to 0.133, p = 0.026) and SMD (rho = 0.417, p < 0.001; adjusted β 0.040 per 1 % increase in CCR, SE 0.006, 95 % CI 0.027 to 0.052, p < 0.001). However, the associations were weaker in participants with chronic kidney disease (CKD), particularly for SMD (interaction p = 0.005).
CCR is associated with CT measures of myopenia and myosteatosis; however, it should be used cautiously in patients with CKD.
骨骼肌（SM）健康状况在老年人群和慢性疾病人群中具有重要的预后价值，但由于评估存在挑战，其评估常常被省略。肌酐与胱抑素C比值（CCR）是一种基于血清的简单测量指标，与测量的SM量（肌少症）和力量密切相关，但其与SM质量（肌脂变）的关联证据有限且相互矛盾。本研究调查了CCR与肌少症和肌脂变的计算机断层扫描（CT）测量指标之间的关联。
在动脉粥样硬化多民族研究的这项横断面分析中，纳入了1035名有完整身体成分测量数据以及访视匹配的血清肌酐和胱抑素C测量数据的参与者。CCR计算为（血清肌酐/血清胱抑素C）×100。肌少症通过SM指数（SMI；根据体表面积标准化的SM面积）进行量化，肌脂变通过CT图像中的SM密度（SMD；基于亨氏单位）进行量化。采用相关分析和多变量线性回归来建立CCR与SMI和SMD之间关系的模型。
CCR与SMI呈正相关且相关（rho = 0.295，p < 0.001；CCR每增加1%，调整后的β为0.071，标准误[SE]为0.032，95%置信区间[CI]为0.009至0.133，p = 0.026）以及与SMD呈正相关且相关（rho = 0.417，p < 0.001；CCR每增加1%，调整后的β为0.040，SE为0.006，95%CI为0.027至0.052，p < 0.001）。然而，在患有慢性肾脏病（CKD）的参与者中，这种关联较弱，尤其是对于SMD（交互作用p = 0.005）。
CCR与肌少症和肌脂变的CT测量指标相关；然而，在CKD患者中应谨慎使用。
