肝切除术前门静脉栓塞患者中肌肉减少症与未来肝残余量肥大之间的相关性。

Correlation between sarcopenia and hypertrophy of the future liver remnant in patients undergoing portal vein embolization before liver resection.

作者信息

Baby Akhil, Patidar Yashwant, Mukund Amar, Srivastava Amol, Kumar Niraj, Sasturkar Shridhar Vasantrao, Tevethia Harsh Vardhan, Pamecha Viniyendra

机构信息

Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.

Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.

出版信息

Br J Radiol. 2025 Apr 1;98(1168):544-550. doi: 10.1093/bjr/tqaf003.

DOI:10.1093/bjr/tqaf003

PMID:39799514

Abstract

OBJECTIVES

To study the correlation between sarcopenia and hypertrophy of the future liver remnant (FLR) in patients undergoing portal vein embolization (PVE) before liver resection, and to assess the outcomes after resection.

METHODS

This retrospective study examined patients underwent PVE from May 2012 to May 2023. Demographic, clinical, and laboratory features were documented and total liver volumes and FLR volumes were measured before and 2-4 weeks after PVE. Degree of hypertrophy (DH), percentage hypertrophy (PH), and kinetic growth rate (KGR) of the FLR were calculated. Sarcopenia was defined using the skeletal muscle index (SMI) at the L3 vertebral level. Subcutaneous adipose index, visceral adipose index (VAI), cross-sectional area of psoas muscle at the largest diameter, and L3 vertebral level mean muscle attenuation (MA) were also assessed.

RESULTS

Forty patients were included in the analysis and the median age was 57.5 (IQR 51-64) and majority were males 27/40(67.5%). Twenty-two patients were non-sarcopenics and 18 were sarcopenics. All patients showed hypertrophy of FLR (P = 0.001). SMI demonstrated moderate positive correlations with DH (r = 0.46, P = 0.003), PH (r = 0.47, P = 0.002), and KGR (r = 0.44, P = 0.004). VAI showed weak positive correlations with DH (r = 0.22, P = 0.17), PH (r = 0.18, P = 0.27), and KGR (r = 0.14, P = 0.37). Pre-PVE FLR demonstrated a weak negative correlation with PH (r = -0.35, P = 0.03) and KGR (r = -0.12, P = 0.47).

CONCLUSIONS

Sarcopenia, specifically SMI, significantly correlates with FLR hypertrophy after PVE. Assessment of sarcopenia and body compartments prior to PVE could help in stratifying and treats patients with impaired FLR growth.

ADVANCES IN KNOWLEDGE

This study with data spanning over 11 years, is the first in the Indian population to demonstrate a significant correlation between SMI, a marker of sarcopenia, and FLR hypertrophy following PVE.

摘要

目的

研究肝切除术前接受门静脉栓塞（PVE）的患者中肌肉减少症与未来肝残余量（FLR）肥大之间的相关性，并评估肝切除术后的结局。

方法

这项回顾性研究纳入了2012年5月至2023年5月接受PVE的患者。记录人口统计学、临床和实验室特征，并在PVE前以及PVE后2 - 4周测量全肝体积和FLR体积。计算FLR的肥大程度（DH）、肥大百分比（PH）和动态生长率（KGR）。使用L3椎体水平的骨骼肌指数（SMI）定义肌肉减少症。还评估了皮下脂肪指数、内脏脂肪指数（VAI）、腰大肌最大直径处的横截面积以及L3椎体水平平均肌肉衰减（MA）。

结果

40例患者纳入分析，中位年龄为57.5岁（四分位间距51 - 64岁），大多数为男性，27/40（67.5%）。22例患者无肌肉减少症，18例有肌肉减少症。所有患者均出现FLR肥大（P = 0.001）。SMI与DH（r = 0.46，P = 0.003）、PH（r = 0.47，P = 0.002）和KGR（r = 0.44，P = 0.004）呈中度正相关。VAI与DH（r = 0.22，P = 0.17）、PH（r = 0.18，P = 0.27）和KGR（r = 0.14，P = 0.37）呈弱正相关。PVE前的FLR与PH（r = -0.35，P = 0.03）和KGR（r = -0.12，P = 0.47）呈弱负相关。