CT定量测量用于肝硬化患者肌少症的诊断价值

Analysis of the diagnostic value of CT quantitative measurement for sarcopenia in patients with liver cirrhosis

目的分析CT定量测量用于肝硬化患者肌少症的诊断价值。方法收集2021年1月至2023年11月在本院诊断为肝硬化的128例患者(研究组)及性别、年龄相匹配的128名健康志愿者(对照组)纳入本研究。测量L3椎体水平骨骼肌面积(SMA-L3)、腰椎骨密度、椎后肌群脂肪浸润(MFI)程度、竖脊肌CT脂肪百分数(CTFF),并计算L3椎体水平骨骼肌指数(SMI-L3)。结果研究组的性别、年龄较对照组差异无统计学意义(P>0.05),SMI-L3、骨密度小于对照组(P<0.05),椎后肌群MFI、竖脊肌CTFF大于对照组(P<0.05)。不同Child-Pugh分级肝硬化患者的性别、年龄比较差异无统计学意义(P>0.05),SMI-L3、骨密度、椎后肌群MFI、竖脊肌CTFF、肌少症发生率比较差异有统计学意义(P<0.05)。有肌少症肝硬化患者的性别、骨密度、椎后肌群MFI、竖脊肌CTFF较无肌少症肝硬化患者差异无统计学意义(P>0.05),SMI-L3小于无肌少症肝硬化患者(P<0.05),年龄大于无肌少症肝硬化患者(P<0.05)。SMI-L3诊断肝硬化患者肌少症的ROC曲线:总体的ROC曲线下面积(95%CI)=0.866(0.804,0.927),男性的ROC曲线下面积(95%CI)=0.957(0.882,1.000),女性的ROC曲线下面积(95%CI)=0.857(0.766,0.948)。根据四格表计算SMI-L3诊断肝硬化患者肌少症的灵敏度91.0%,特异度90.2%,阳性预测值91.0%,阴性预测值90.2%,约登指数0.812。结论CT定量测量在肝硬化患者肌少症的诊断中有重要价值。

Objective To analyze the diagnostic value of CT quantitative measurement for sarcopenia in patients with liver cirrhosis.Methods From January 2021 to November 2023,128 patients diagnosed with liver cirrhosis in our hospital(study group)and 128 healthy individuals matched in gender and age(control group)were included in this study.The skeletal muscle area at the third lumbar vertebral plane(SMA-L3),lumbar spine bone density,degree of fat infiltration in the posterior muscle fatty infiltration(MFI),CT fat percentage in the erector spinae muscle(CTFF)were measured,and the skeletal muscle index at the third lumbar vertebral plane(SMI-L3)was calculated.Results There was no statistically significant difference in gender and age between the study group and the control group(P>0.05).SMI-L3 and bone density were lower than those in the control group(P<0.05),while posterior vertebral muscle MFI,and erector spinae CTFF were higher than those in the control group(P<0.05).There was no statistically obvious difference in gender and age among patients with different Child-Pugh grades of liver cirrhosis(P>0.05),while there were statistically significant differences in SMI-L3,bone density,posterior vertebral muscle group MFI,erector spinae muscle CTFF,and incidence of sarcopenia(P<0.05).There was no statistically obvious difference in gender,bone density,posterior vertebral muscle group MFI,and erector spinae muscle CTFF between patients with sarcopenia cirrhosis and those without sarcopenia cirrhosis(P>0.05),SMI-L3 was smaller than that of patients without sarcopenia cirrhosis(P<0.05),and older than that of patients without sarcopenia cirrhosis(P<0.05).ROC curve of SMI-L3 in diagnosing sarcopenia in patients with liver cirrhosis:the overall area under the receiver operator characteristic curve(ROC)curve(95%CI)was 0.866(0.804,0.927),the area under the ROC curve of males(95%CI)was 0.957(0.882,1.000),and the area under the ROC curve of female(95%CI)was 0.857(0.766,0.948).According to the four-grid table,the sensitivity and specificity of SMI-L3 in diagnosing sarcopenia in patients with liver cirrhosis were 91.0%,90.2%,91.0%,90.2%,and 0.812,respectively.Conclusion CT quantitative measurement has important value in the diagnosis of sarcopenia in patients with liver cirrhosis.