肌脂肪变性作为肾移植受者手术并发症的新危险因素：一项回顾性研究
Myosteatosis as a New Risk Factor of Surgical Complications in Kidney Transplant Recipients: A Retrospective Study.
作者信息
Morel Antoine, Ouamri Yaniss, Ségaux Lauriane, Zaidan Louai, Moryoussef Michael, Mulé Sébastien, Champy Cécile Maud, Reizine Edouard, Ingels Alexandre, Luciani Alain, Grimbert Philippe, Canouï-Poitrine Florence, Matignon Marie, Pigneur Frédéric, Stehlé Thomas
机构信息
Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.
Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative therapy for immune disorders", Créteil, France.
出版信息
J Cachexia Sarcopenia Muscle. 2025 Jun;16(3):e13746. doi: 10.1002/jcsm.13746.
BACKGROUND
Computed tomography (CT) scan-defined myosteatosis is a common feature in ESKD patients receiving kidney transplantation (KT) and is associated with mortality after KT. We aimed to explore the impact of myosteatosis and other CT scan based morphometric data on the occurrence of early surgical complications after KT.
METHODS
We retrospectively measured on an unenhanced cross-sectional CT scan taken at the middle of the third lumbar vertebra performed within the previous year or at the time of KT: surface muscle index (total lumbar cross-sectional muscle area [CSMA] divided by height squared), subcutaneaous adipose tissue index, visceral adipose tissue index and muscle density (MD: mean CT attenuation of CSMA). Vessel to skin distance was the distance between iliac vein and skin. Myosteatosis was defined as MD below age- and sex-specific normal values. Logistic regression models were constructed to identify predictive factor of 90 days postoperative surgical complications with Clavien-Dindo score greater than or equal to 2, CD ≥ 2).
RESULTS
Among the N = 200 patients, 61.5% were male with a mean age of 54.8 (± 13.8) years and a mean BMI of 25.1 (± 4.4) kg/m. Sixty patients (30%) developed at least one postoperative complication (CD ≥ 2) in the first 3 months after KT. In two different multivariate analyses, MD (aOR: 0.95 for one Hounsfield unit increase, 95% CI: 0.91-0.99, p = 0.028) and myosteatosis status (aOR: 4.64, 95% CI: 2.18-9.90, p < 0.0001) were the only independent risk factors for postsurgical complication.
CONCLUSIONS
Myosteatosis is independently associated with the occurrence of CD ≥ 2 postoperative complication within 90 days of surgery.
背景
计算机断层扫描（CT）定义的肌脂肪变性是接受肾移植（KT）的终末期肾病（ESKD）患者的常见特征，并且与KT后的死亡率相关。我们旨在探讨肌脂肪变性和其他基于CT扫描的形态学数据对KT后早期手术并发症发生情况的影响。
方法
我们回顾性测量了前一年或KT时在第三腰椎中部进行的非增强横断面CT扫描：表面肌肉指数（总腰椎横断面肌肉面积[CSMA]除以身高平方）、皮下脂肪组织指数、内脏脂肪组织指数和肌肉密度（MD：CSMA的平均CT衰减值）。血管到皮肤的距离是髂静脉与皮肤之间的距离。肌脂肪变性定义为MD低于年龄和性别特异性正常值。构建逻辑回归模型以确定术后90天手术并发症（Clavien-Dindo评分大于或等于2，CD≥2）的预测因素。
结果
在N = 200例患者中，61.5%为男性，平均年龄为54.8（±13.8）岁，平均体重指数为25.1（±4.4）kg/m²。6。60例患者（30%）在KT后的前3个月内发生了至少一种术后并发症（CD≥2）。在两项不同的多变量分析中，MD（每增加一个亨氏单位的调整后比值比：0.95，95%置信区间：0.91-0.99，p = 0.028）和肌脂肪变性状态（调整后比值比：4.64，95%置信区间：2.18-9.90，p < 0.0001）是术后并发症的唯一独立危险因素。
结论
肌脂肪变性与术后90天内发生CD≥2的术后并发症独立相关。
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