骨骼肌指数对慢性阻塞性肺疾病机械通气患者预后的预测价值

CT-derived skeletal muscle index as an independent predictor of mortality among acute exacerbation COPD patients requiring mechanical ventilation

目的探讨胸部CT单一层面影像上测量的骨骼肌指数对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)因呼吸衰竭需要机械通气患者预后的预测价值。方法回顾性分析2013年2月至2018年12月扬州大学附属医院收治的386例因呼吸衰竭需机械通气的AECOPD患者的临床及影像学资料。所有患者随访至2019年10月31日。根据30d预后情况分为存活组(279例)和死亡组(107例),比较两组患者的年龄、性别、临床资料及第8胸椎水平骨骼肌指数(skeletal muscle index at the 8th thoracic vertebra level,T8SMI)、第12胸椎水平背部肌群骨骼肌指数(the dorsal muscle index at the 8th thoracic vertebra level,T12DMI)等影像学指标。通过logistic回归及Cox风险比例模型分析AECOPD机械通气患者30d及长期预后的预测因子。结果存活组与死亡组患者的年龄、格拉斯哥评分、急性生理与慢性健康评分Ⅱ评分、有创机械通气、白细胞计数、中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值、C反应蛋白、T8SMI、T12DMI组间差异均有显著性。Logistic多因素回归分析显示,T8SMI、T12DMI均可独立预测AECOPD机械通气患者的30d预后。Cox风险比例模型多因素分析显示,校正年龄、性别等因素后,T8SMI、T12DMI仍可独立预测AECOPD机械通气患者的长期预后。结论通过胸部CT测量的骨骼肌指数T8SMI、T12DMI可独立预测AECOPD机械通气患者的30d及长期预后。

Objective This study sought to identify if the skeletal muscle index measured from chest computed tomography(CT)image as an independent predictor of mortality among patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)requiring mechanical ventilation(MV).Method This was a single-center retrospective case-control study.Clinical and radiographic data were collected from 386 AECOPD patients requiring mechanical ventilation for respiratory failure admitted to the Affiliated Hospital of Yangzhou University from February 2013 to December 2018.The univariate analysis was performed between the deceased group and the surviving group based on 30d mortality.Multivariate regression logistic models were constructed to identify the prognostic markers of 30d mortality.Cox multivariate regression model was established to estimate the prognostic factors on long-term survival.The cutoff value of skeletal muscle area or skeletal muscle index obtained from the receiver operating characteristic(ROC)curve analysis based on 30d mortality.Result Age,Glasgow coma score(GCS),acute physiology and chronic health evaluation(APACHEⅡ)scores,invasive mechanical ventilation(IMV),WBC,invasive mechanical ventilation(IMV),neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),C reactive protein(CRP),the skeletal muscle index at the T8 vertebral level(T8SMI),the dorsal muscle index at the T12 vertebral level(T12DMI)showed significant differences between the deceased group and the surviving group based on 30d mortality.The T8SMI、T12DMI respectively accompany with NLR and APACHE II scores in the multivariate regression logistic models.They were independent prognostic factors for predicting the 30d mortality.After adjust from gender in the final multivariate Cox regression model,T8SMI、T12DMI were independent predictors of long-term survival of patients.Conclusion T8SMI、T12DMI were independent prognostic factors of 30d mortality and long-term survival among COPD patients requiring mechanical ventilation.