摘要
目的:通过腹部多层螺旋计算机体层摄影(MDCT)上测量第3腰椎体最大层面骨骼肌横断面积(L3-SMA),并分析骨骼肌减少症与失代偿期肝硬化患者发生上消化道出血风险的相关性。方法:回顾性分析167例失代偿期肝硬化患者的临床病历资料及腹部MDCT图像,依据是否发生上消化道出血分为出血组(n=50)和未出血组(n=117)。为均衡年龄、性别及体质量指数(BMI)变量,采用倾向性评分匹配肝硬化出血组和未出血组的病例。在腹部平扫MDCT图像上测量成功匹配两组病例的L3-SMA和皮下脂肪面积(L3-SFA),基于L3-SMA计算骨骼肌指数,参考骨骼肌指数值(SMI)诊断失代偿期肝硬化患者发生骨骼肌减少症的比例。比较两组患者的临床基本特征、实验室检测指标、肝功能Child-Pugh分级、L3-SMA、L3-SFA和骨骼肌减少症发生率的差异。应用多因素Logistic回归分析与失代偿期肝硬化患者发生上消化道出血风险相关的独立危险因素。结果:在167例失代偿期肝硬化患者中,50例(29.94%)患者出现上消化道出血。倾向性评分匹配后,肝硬化出血组和未出血组成功匹配39对病例。基于L3-SMA和骨骼肌指数值,在39对肝硬化出血组和未出血组病例中,29例(74.35%)和14例(35.90%)分别诊断为骨骼肌减少症。Child-Pugh分级、白蛋白、血浆凝血酶原时间、SMA及骨骼肌减少症发生率在肝硬化出血组和未出血组间差异有统计学意义(P<0.05)。多因素Logistic回归分析显示凝血酶原时间、骨骼肌减少症是失代偿期肝硬化患者发生上消化道出血的独立危险因素(P<0.05)。结论:骨骼肌减少症是失代偿期肝硬化患者常见的共存疾病,可以用于预测失代偿期肝硬化患者发生上消化道出血的风险。
Objective:To measure the cross-section area of skeletal muscle at the largest level of the third lumbar(L3-SMA)on Multi-detector Computed Tomography(MDCT),and analyze the correlation between sarcopenia and the risk of upper gastrointestinal bleeding in patients with decompensated cirrhosis.Methods:The clinical data and abdominal MDCT images of 167 patients with decompensated cirrhosis were retrospectively analyzed,and they were divided into bleeding group(n=50)and non-bleeding group(n=117)based on the presence or absence of upper gastrointestinal bleeding.In order to equalize age,sex and body mass index(BMI)variables,a propensity scores was used to match patients between bleeding group and non-bleeding group.L3-SMA and subcutaneous fat area at the largest level of the third lumbar(L3-SFA)were measured in the successfully matched patients of the two groups on abdominal MDCT.Skeletal muscle index(SMI)was calculated based on L3-SMA and used to diagnose the incidence of sarcopenia in patients with decompensated cirrhosis.The clinical baseline characteristics,laboratory test index,Child-Pugh grading of liver function,L3-SMA,L3-SFA,and incidence of sarcopenia were compared between the successfully matched patients of the two groups.The risk of upper gastrointestinal bleeding were analyzed by multivariate Logistic regression analysis in patients with decompensated cirrhosis.Results:In the 167 patients with decompensated cirrhosis,50 patients(29.9%)were diagnosed with upper gastrointestinal bleeding.After propensity score matching,39 pairs of cases were successfully matched in liver cirrhosis with bleeding and without bleeding.According the values of L3-SMA and SMI,29 cirrhosis patients with bleeding(74.35%)and 14 cirrhosis patients without bleeding(35.90%)were diagnosed with sarcopenia in the 39 pairs of cases,respectively.The Child-Pugh grading of liver function,albumin,plasma prothrombin time,L3-SMA and incidence of sarcopenia were significant difference between the two groups(P<0.05).Multivariate Logistic regression
作者
李枝春
雷燕
朱婷婷
李勇
唐伟
张小明
LI Zhi-chun;LEI Yan;ZHU Ting-ting;LI Yong;TANG Wei;ZHANG Xiao-ming(Sichuan Key Laboratory of Medical Imaging,Department of Radiology,Affiliated Hospital of North Sichuan Medical College;Department of Clinical Laboratory,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)
出处
《川北医学院学报》
CAS
2023年第11期1485-1491,共7页
Journal of North Sichuan Medical College
基金
医学影像四川省重点实验室开放课题基金(MIKLSP202006)
南充市科学技术局市校合作专项基金(22SXZRKX0006)
川北医学院附属医院2021博士启动基金(210832)。
关键词
肝硬化
上消化道出血
骨骼肌减少症
Liver Cirrhosis
Upper gastrointestinal bleeding
Sarcopenia
