腰大肌及侧腹肌相关CT参数评价肝硬化肌少症

目的 观察腰大肌及侧腹肌相关CT参数评价肝硬化肌少症的价值。方法 采集210例临床诊断肝硬化患者腹部CT，获得L3水平骨骼肌总横截面积，计算相应骨骼肌指数（SMI）。根据SMI结果将患者分为肌少症组（n=105）与非肌少症组（n=105），测量相同层面右侧腰大肌轴径及横径、右侧腹肌厚度，计算腰大肌轴径指数（APMI）、腰大肌横径指数（TPDI）及侧腹肌厚度指数（LWMI）；比较组间差异。以SMI结果为标准，绘制TPDI、APMI及LWMI鉴别肝硬化肌少症的受试者工作特征（ROC）曲线，计算曲线下面积（AUC），并分析TPDI、APMI及LWMI与SMI的相关性及肌少症的影响因素。结果 组间体质量指数、胆固醇、NRS2002评分、APMI、TPDI和LWMI差异均有统计学意义（P均<0.05）。TPDI（r=0.71）、APMI（r=0.59）和LWMI（r=0.61）均与SMI呈正相关（P均<0.01）。APMI、TPDI及LWMI鉴别肝硬化肌少症的AUC分别为0.61、0.71及0.72（P均<0.05）。男性、三酰甘油为肌少症的危险因素，TPDI、LWMI为肌少症的保护因素（P均<0.05）。结论 腰大肌及侧腹肌相关CT参数可用于评估肝硬化肌少症，并有望成为临床评估肌少症的新方法。

Psoas and lateral abdominal muscles related CT parameters for evaluating liver cirrhosis with sarcopenia

Objective To observe the value of psoas and lateral abdominal muscles related CT parameters in evaluation on liver cirrhosis with sarcopenia. Methods Abdominal CT of 210 patients with liver cirrhosis were collected to obtain the total cross-sectional area of skeletal muscle at the level of L3, then the corresponding skeletal muscle index (SMI) was calculated. The patients were divided into sarcopenia group (n=105) and non-sarcopenia group (n=105) according to SMI. The axial diameter and transverse diameter of the right psoas major and the thickness of the right abdominal muscle were measured at the same level, and the corresponding axial psoas muscle index (APMI), transverse psoas diameter index (TPDI) and lateral wall muscle index (LWMI) were calculated. The general information and CT parameters were compared between groups. Taken SMI results as the standards, the receiver operating characteristic (ROC) curves of TPDI, APMI and LWMI for identifying liver cirrhosis with sarcopenia were drawn, and the area under the curve (AUC) was calculated. The correlations of TPDI, APMI, LWMI with SMI and the impact factors of sarcopenia were analyzed. Results There were significant differences of body mass index, cholesterol, NRS2002 score, APMI, TPDI and LWMI between groups (all P<0.05). TPDI (r=0.71), APMI (r=0.59) and LWMI (r=0.61) were all positively correlated with SMI (all P<0.01). AUC of APMI, TPDI and LWMI for identifying liver cirrhosis with sarcopenia was 0.61, 0.71 and 0.72, respectively (all P<0.05). Male and triglyceride were risk factors, while TPDI and LWMI were protective factors of sarcopenia (all P<0.05). Conclusion Psoas and lateral abdominal muscles related CT parameters could be used to evaluate liver cirrhosis with sarcopenia, which might be a new method for clinical evaluation of sarcopenia.