肌肉减少症在主动脉瓣置换术中的预后价值：一项系统评价和荟萃分析。
Prognostic value of sarcopenia in aortic valve replacement: a systematic review and meta-analysis.
作者信息
He Jie
机构信息
School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, China.
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China.
出版信息
Front Nutr. 2025 Jul 29;12:1529270. doi: 10.3389/fnut.2025.1529270. eCollection 2025.
OBJECTIVE
This study aimed to quantify the prevalence of sarcopenia in patients undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), and to assess its association with mortality risk.
METHODS
Relevant studies were identified through searches of the PubMed, Cochrane Library, Excerpta Medica Database (Embase), Web of Science, and China National Knowledge Infrastructure (CNKI) from inception through July 1, 2025. The prevalence of sarcopenia and its 95% confidence interval (CI) were calculated, with heterogeneity evaluated using the statistic. The link between sarcopenia and mortality following SAVR/TAVR was quantified by hazard ratio (HR) or odds ratio (OR) with 95% CI. Statistical analyses were conducted using Stata 11.0.
RESULTS
Thirty-eight studies were included, with 6 focusing on patients undergoing SAVR and 32 on those undergoing TAVR. Sarcopenia was defined by skeletal mass index in 16 studies, while only 2 studies adopted criteria combining reduced muscle mass with low muscle strength and/or reduced physical performance. Sarcopenia's prevalence among SAVR patients was 31.3% (95% CI 25.3-37.6%). In this cohort, sarcopenia was linked to a significantly higher risk of long-term (≥1 year) mortality (HR = 3.10, 95% CI 2.00-4.79, < 0.001). In contrast, the prevalence of sarcopenia in TAVR patients was 43.7% (95% CI 38.6-48.9%), with sarcopenia also correlating with increased long-term (>2 year) mortality (HR = 1.25, 95% CI 1.09-1.44, = 0.001). These associations remained consistent across various follow-up durations, definitions of sarcopenia, and ethnic groups.
CONCLUSION
Despite the variation in diagnostic criteria, sarcopenia is significantly prevalent in both SAVR and TAVR populations, with a clear association with elevated long-term mortality following these procedures.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024606633.
目的
本研究旨在量化接受外科主动脉瓣置换术（SAVR）或经导管主动脉瓣置换术（TAVR）患者的肌肉减少症患病率，并评估其与死亡风险的关联。
方法
通过检索PubMed、Cochrane图书馆、医学文摘数据库（Embase）、科学网和中国知网，从建库至2025年7月1日确定相关研究。计算肌肉减少症的患病率及其95%置信区间（CI），使用 统计量评估异质性。通过风险比（HR）或比值比（OR）及95%CI量化SAVR/TAVR后肌肉减少症与死亡率之间的关联。使用Stata 11.0进行统计分析。
结果
纳入38项研究，其中6项关注接受SAVR的患者，32项关注接受TAVR的患者。16项研究通过骨骼肌质量指数定义肌肉减少症，而只有2项研究采用将肌肉量减少与低肌肉力量和/或身体功能下降相结合的标准。SAVR患者中肌肉减少症的患病率为31.3%（95%CI 25.3 - 37.6%）。在该队列中，肌肉减少症与长期（≥1年）死亡风险显著升高相关（HR = 3.10，95%CI 2.00 - 4.79， < 0.001）。相比之下，TAVR患者中肌肉减少症的患病率为43.7%（95%CI 38.6 - 48.9%），肌肉减少症也与长期（>2年）死亡率增加相关（HR = 1.25，95%CI 1.09 - 1.44， = 0.001）。这些关联在不同的随访时间、肌肉减少症定义和种族群体中均保持一致。
结论
尽管诊断标准存在差异，但肌肉减少症在SAVR和TAVR人群中均显著普遍，且与这些手术后长期死亡率升高有明确关联。
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