Cao Yujia, Yuan Baoyu, Jiang Xiuyu, Xie Chunming, Wu Di, Zhang Zhijun
Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Institution of Neuropsychiatry, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing, Jiangsu, China.
Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
J Cachexia Sarcopenia Muscle. 2025 Jun;16(3):e13827. doi: 10.1002/jcsm.13827.
Skeletal muscle parameters at the first lumbar vertebra (L1) level on computed tomography (CT) are common indicators for muscle mass. However, their relationship with the severity and prognosis of amyotrophic lateral sclerosis (ALS) patients remains unclear.
This cohort study included ALS patients who underwent chest CT scans between January 2018 and January 2022 and healthy controls (HCs) matched for gender and age. Overall survival (OS) was determined from the date of chest CT to death, tracheal intubation or 1 January 2024. Using ImageJ software, skeletal muscle area and density (L1 SMA/SMD), skeletal muscle index (L1 SMI), paraspinal muscle area and density (L1 PMA/PMD) and subcutaneous fat area and density (L1 SFA/SFD) at L1 were quantified. The relationships between the quantified muscle parameters and both King's clinical stages and the Revised ALS Functional Rating Scale (ALSFRS-R) were analysed. The Cox proportional hazard model was used to evaluate the hazard ratio (HR) of skeletal muscle parameters as risk factors for outcome events, and to construct a nomogram.
Muscle parameters in ALS patients (n = 102; 36.27% female; mean age, 60.85 ± 10.58 years) were significantly lower compared with HCs (p < 0.001). L1 SMD (p = 0.047) and L1 PMD (p = 0.003) both differed significantly across the King's clinical stages. ALSFRS-R scores correlated with L1 SMA (r = 0.35, p < 0.001), L1 SMI (r = 0.34, p < 0.001), L1 PMA (r = 0.27, p = 0.007) and L1 PMD (r = 0.27, p = 0.007). Multivariate Cox regression analysis revealed that L1 SMA (HR = 0.96, 95% confidence interval [CI] = 0.94-0.98, p = 0.001), L1 SMD (HR = 0.92, 95% CI = 0.88-0.96, p < 0.001) and L1 PMA (HR = 1.06, 95% CI = 1.01-1.11, p = 0.022) significantly influenced ALS survival, with area under the curves (AUCs) of 0.687 and 0.851 for 1- and 3-year OS prediction. The consistency index (C-index) for the nomogram was 0.72 (95% CI = 0.641-0.793).
Skeletal muscle parameters at L1 level on CT are significantly associated with clinical severity and prognosis in ALS.
Chinese Clinical Trial Registration Center: ChiCTR230078702.
计算机断层扫描（CT）上第一腰椎（L1）水平的骨骼肌参数是肌肉量的常用指标。然而，它们与肌萎缩侧索硬化症（ALS）患者的严重程度和预后之间的关系仍不清楚。
这项队列研究纳入了2018年1月至2022年1月期间接受胸部CT扫描的ALS患者以及性别和年龄匹配的健康对照（HCs）。总生存期（OS）从胸部CT日期计算至死亡、气管插管或2024年1月1日。使用ImageJ软件，对L1水平的骨骼肌面积和密度（L1 SMA/SMD）、骨骼肌指数（L1 SMI）、椎旁肌面积和密度（L1 PMA/PMD）以及皮下脂肪面积和密度（L1 SFA/SFD）进行量化。分析量化后的肌肉参数与King临床分期以及修订的ALS功能评定量表（ALSFRS-R）之间的关系。采用Cox比例风险模型评估骨骼肌参数作为结局事件危险因素的风险比（HR），并构建列线图。
与HCs相比，ALS患者（n = 102；女性占36.27%；平均年龄60.85±10.58岁）的肌肉参数显著更低（p < 0.001）。L1 SMD（p = 0.047）和L1 PMD（p = 0.003）在King临床分期之间均存在显著差异。ALSFRS-R评分与L1 SMA（r = 0.35，p < 0.001）、L1 SMI（r = 0.34，p < 0.001）、L1 PMA（r = 0.27，p = 0.007）和L1 PMD（r = 0.27，p = 0.007）相关。多因素Cox回归分析显示，L1 SMA（HR = 0.96，95%置信区间[CI] = 0.94 - 0.98，p = 0.001）、L1 SMD（HR = 0.92，95% CI = 0.88 - 0.96，p < 0.001）和L1 PMA（HR = 1.06，95% CI = 1.01 - 1.11，p = 0.022）对ALS生存期有显著影响，1年和3年OS预测的曲线下面积（AUC）分别为0.687和0.851。列线图的一致性指数（C-index）为0.72（95% CI = 0.
