第三腰椎腰大肌面积指数对肝硬化患者营养状态及预后评估价值

Evaluation value of area index of the third lumbar psoas major muscle in nutritional status and prognosis of patients with cirrhosis

目的探讨第三腰椎(L3)腰大肌面积指数(PMI)对肝硬化患者营养状态及预后的评估价值。方法回顾性分析自2017年12月至2020年12月北部战区总医院消化内科收治的150例肝硬化患者的临床资料。使用Slice Omatic软件测量患者L3层面腰大肌面积,并计算PMI。采用受试者工作特征(ROC)曲线分别确定男性L3-PMI、女性L3-PMI、肝功能(Child-Pugh)评分、终末期肝病模型(MELD)评分对患者预后的预测价值。使用约登指数确定L3-PMI预测患者生存的最佳界值,并根据临界值将患者分为少肌症组和无少肌症组,比较两组各项临床指标。使用Kaplan-Meier法对少肌症组和无少肌症组进行生存分析。结果Child-Pugh评分、MELD评分、男性L3-PMI、女性L3-PMI鉴别肝硬化患者死亡的ROC曲线下面积分别为0.773、0.668、0.589、0.746。男性L3-PMI诊断最佳界值为6.055,女性L3-PMI诊断最佳界值为2.360。少肌症组与无少肌症组男性比例、年龄、红细胞计数、血红蛋白、白蛋白、肌酐、L3-PMI比较,差异均有统计学意义(P<0.05)。少肌症组患者存活率为68.42%(39/57),显著低于无少肌症组的89.25%(83/93),两组比较,差异有统计学意义(χ^(2)=5.140,P<0.05)。结论L3-PMI可有效反映肝硬化患者的营养状态,由L3-PMI评价的少肌症对肝硬化患者随访期间死亡具有较高的预测价值。

Objective To evaluate the nutritional status and prognosis of patients with cirrhosis with psoas muscle index(PMI)of the third lumbar spine(L3).Methods The clinical data of 150 patients with cirrhosis admitted to the Department of Gastroenterology of General Hospital of Northern Theatre Command from December 2017 to December 2020 were retrospectively analyzed.Slice Omatic software was used to measure the psoas major muscle area at L3 level and calculate PMI.Receiver operating characteristic(ROC)curve was used to determine the predictive value of male L3-PMI,female L3-PMI,Child-Pugh score and model for end stage liver disease(MELD)score for patients′prognosis.Youden index was used to determine the optimal threshold of L3-PMI for predicting patient survival,and patients were divided into sarcopenia group and non-sarcopenia group according to the threshold,and the clinical indicators of the two groups were compared.Kaplan-Meier method was used to analyze the survival of patients with sarcopenia and those without sarcopenia.Results The areas under curve of ROC for Child-Pugh score,MELD score,male L3-PMI and female L3-PMI to identify death in patients with cirrhosis were 0.773,0.668,0.589 and 0.746.The optimal diagnostic threshold of L3-PMI was 6.055 for males and 2.360 for females.There were statistically significant differences in male proportion,age,red blood cell count,hemoglobin,albumin,creatinine and L3-PMI between the sarcopenia group and the non-sarcopenia group(P<0.05).The survival rate of patients with sarcopenia was 68.42%(9/57),significantly lower than that of patients without sarcopenia(89.25%,83/93),and the difference between the two groups was statistically significant(χ^(2)=5.140,P<0.05).Conclusion L3-PMI can effectively reflect the nutritional status of patients with cirrhosis,and sarcopenia evaluated by L3-PMI has a high predictive value for mortality in patients with cirrhosis during follow-up.