Low skeletal muscle mass and high visceral adiposity are associated with recurrence of acute cholecystitis after conservative management:A propensity score-matched cohort study

Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity have various effects in several diseases.We aimed to clarify the relationship between RAC and body parameters.Methods:Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled.The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC.The areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI groups.We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC.Results:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)groups.In the propensity score-matched cohort there were 57 patients in each group.In Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),respectively.Conclusions:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.

Age-dependent Changes in Skeletal Muscle Mass and Visceral Fat Area in a Chinese Population

Objective:The present study was conducted to demonstrate the age-dependent changes in skeletal muscle mass and visceral fat area in a population of Chinese adults aged 30-92 years old.Methods:A total of 6669 healthy Chinese men and 4494 healthy Chinese women aged 30-92 years old were assessed for their skeletal muscle mass and visceral fat area.Results:The results showed age-dependent decreases in the total skeletal muscle mass indexes in both men and women aged 40-92 years old as well as age-dependent increases in the visceral fat area in men aged 30-92 years old and in women aged 30-80 years old.Multivariate regression models showed that the total skeletal muscle mass index was positively associated with the body mass index and negatively associated with the age and visceral fat area in both sexes.Conclusion:The loss of skeletal muscle mass becomes obvious at approximately 50 years of age,and the visceral fat area commences to increase at approximately 40 years of age in this Chinese population.

Relationship between Dual-Energy X-Ray Absorptiometry-Derived Appendicular Lean Tissue Mass and Total Body Skeletal Muscle Mass Estimated by Ultrasound

Dual-energy X-ray absorptiometry (DXA) is an attractive method for evaluating sarcopenia, age-related loss of skeletal muscle mass and function, using appendicular lean tissue (aLT) mass for criteria of diagnosis, although minimal radiation is exposed. Skeletal muscle (SM) mass can be estimated by using ultrasound-measured muscle thickness (MTH). However, the association between these two methods is unclear. To examine the relationship between DXA-derived aLT mass and total body SM mass estimated by ultrasound, thirty-six healthy adults (18 men and 18 women) aged 19 - 65 years participated in this study. Ultrasound-measured muscle thickness was used to estimate the total SM mass. DXA was used to estimate whole body and regional body composition, and aLT mass was considered equivalent to the sum of lean tissue in both the right and left arms and legs. Total SM mass (26.3 ± 4.4 kg for men and 15.7 ± 2.6 kg for women) estimated by ultrasound was similar to DXA-estimated aLT mass (24.5 ± 3.8 kg for men and 15.7 ± 2.7 kg for women). There was a strong correlation between DXA-measured aLT mass and total SM mass estimated by ultrasound in men (r = 0.927, n = 18) and women (r = 0.931, n = 18) as well as overall sample (r = 0.975, n = 36). The ratio of total SM mass to aLT mass was 1.07 for men and 1.00 for women. These results suggest that DXA-derived aLT mass can be accurately predicted from ultrasound estimated total SM mass, although the predicted value may underestimate in men (approximately 7% at the group level).

Urinary Creatinine-Skeletal Muscle Mass Method:A Prediction Equation Based on Computerized Axial Tomography

A classic body composition method is estimation of total body skeletal muscle mass (SM, kg) from 24 h urinary creatinine excretion (Cr, g). Two types of prediction equations were suggested: one assumes a constant SM/Cr ratio; and the other assumes a highly variable SM/Cr ratio. We explored these two extreme possibilities by measuring SM with whole-body computerized axial tomography and collecting Cr during meat-free dietary conditions in 12 healthy young men. Prediction equations were developed in the men that fit these two equation types, SM = 21.8×Cr (SD and CV of SM/Cr ratio, 1.3 kg and 6.0%,respectively) and SM = 18.9 × Cr + 4.1 (r = 0.92, p = 2.55 × 10-5, and SEE = 1.9 kg). The validity of each model is reviewed. This is the first investigation of Cr-SM method using modern techniques for quantifying total body SM mass

Impact of Lifestyle Intervention on the Estimated Visceral Fat Area and Skeletal Muscle Mass in Men with Obesity

Background: The lifestyle modification remains the fundamental approach for the obesity treatment. The aim of this study is to demonstrate the effect of the multimodal lifestyle intervention on the estimated visceral fat area versus changes in musculoskeletal mass in a cohort of adult men with obesity. Subjects and Methods: A retrospective cohort study in which the file of eighty-two male subjects, aged 20 - 60 years, was studied for three months. Patients had been instructed to follow a balanced-hypocaloric diet, physical activity plan and general advice for combating the unhealthy lifestyle habits through the study period. Those who succeeded to loss > 5% of their body weight were classified as weight loser (WL) group, while others as weight resistant (WR) group. The results of In Body-720 bioelectric impedance analysis were used to report the fat mass (FM), visceral fat area (VFA), skeletal muscle mass (SMM), SMM/VFA ratio, osseous mass (OM), and basal metabolic rate (BMR) before and after the study period. Anthropometric measures, glucose, and lipid profile were also analyzed. Paired t-test was used to detect the significance of change between before and after measures, independent sample t-test was used to compare WL vs. WR groups. Results: There were significant decreases in weight, FM (p 0.05) and VFA (p 0.001), in addition to a significant rise of SMM/VFA ratio (p 0.05), together with insignificant changes of osseous mass, SMM and BMR after 3 months. Additionally, total cholesterol, low-density lipoprotein, and triglycerides were significantly reduced (P 0.05). The percentages of reduction in weight, FM and VFA in WL vs. WR groups were highly significant (p 0.001), while the percentages of change in SMM, SMM/VFA ratio and BMR were significant (p 0.05). Conclusion: Lifestyle modification might be effective in production of positive changes in the body composition of patients with obesity. These changes were more significant in weight losers.

Comparison of the Two Algorithms of Skeletal Muscle Mass Index: An Observational Study in a Large Cohort of Chinese Adults

Objective: To compare the two skeletal muscle mass index (SMI) algorithms. One is SMM [SMM(%) = total skeletal muscle mass (kg)/body weight mass (kg) × 100%];and the other is SMH [SMH (kg/m2) = total skeletal muscle mass (kg)/height (m)2]. Methods: Body composition, body mass index (BMI) and body fat percentage (BFP) were estimated using a bioelectrical impedance analyzer. SMI was calculated by the two algorithms described above, and measurement parameters were stratified by age, BMI and levels of physical activity. Results: Levels of BMI, BFP, SMM and SMH differed significantly between the sexes. BMI and BFP were positively associated with age, while SMM was negatively associated with age (β = −0.2294, P < 0.001). Furthermore, SMM was determined to have a negative association with BMI (β = −0.5340, P < 0.001), while a positive association between SMH and BMI (β = 0.7930, P β = −0.9849, P β = −0.0642, P < 0.001) were negatively associated with BFP. In both men and women, SMM maintained the analogous correlation with other indicators. In the general population, SMM showed a gradual downward trend from low body weight to grade III obesity (F = 9528.32, P < 0.001), but SMH (F = 34395.46, P F = 9706.20, P < 0.001) had a reciprocal association. BMI, BFP and SMM differences were observed based on levels of physical activity (P < 0.001). However, there was no significant difference in SMH based on exercise (P > 0.05). Conclusions: SMM may be a more ideal and accurate clinical algorithm for SMI because it is more tightly associated with other body composition indices, as compared with SMH.

Prognostic value of computed tomography derived skeletal muscle mass index in lung cancer:A meta-analysis

BACKGROUND The prognostic role of the skeletal muscle mass index(SMI)derived from computed tomography(CT)imaging been well verified in several types of cancers.However,whether the SMI could serve as a reliable and valuable predictor of long-term survival in lung cancer patients remains unclear.AIM To identify the prognostic value of the CT-derived SMI in lung cancer patients.METHODS The PubMed,Web of Science,and Embase electronic databases were searched up to November 5,2021 for relevant studies.The Reference Citation Analysis databases were used during the literature searching and selection.Hazard ratios(HRs)and 95%confidence intervals(CIs)were calculated to assess the association of the SMI with the overall survival(OS)of lung cancer patients.All statistical analyses were performed with STATA 12.0 software.RESULTS A total of 12 studies involving 3002 patients were included.The pooled results demonstrated that a lower SMI was significantly related to poorer OS(HR=1.23,95%CI:1.11-1.37,P<0.001).In addition,the subgroup analyses stratified by treatment(nonsurgery vs surgery),tumor stage(advanced stage vs early stage),and tumor type(non-small cell lung cancer vs lung cancer)showed similar results.CONCLUSION The CT-derived SMI is a novel and valuable prognostic indicator in lung cancer and might contribute to the clinical management and treatment of lung cancer patients.

Loss of skeletal muscle mass is not specific to type 2 diabetes

Skeletal muscle is a massive insulin-sensitive tissue in the body.Loss of muscle mass is associated with mitochondrial dysfunction,and is often a result of diabetes.Insulin deficiency or insulin resistance can only be seen as reduced skeletal muscle mass.Diabetes is caused by insulin deficiency or insulin resistance;however,insulin resistance is not unique to diabetics.Insulin resistance also exists in many diseases.

Possibilities of Assessing Respiratory Muscle Strength and Trunk Muscle Mass in the Prevention of Sarcopenia in Older People Living in the Community

Objective: The purpose of this study was to clarify the relationship between respiratory muscle strength and skeletal muscle mass (trunk, upper limbs, and lower limbs) in older people who were certified as requiring nursing or supportive care. Methods: Thirty-five older people (65 years or older) who were certified as requiring nursing care or support were included in the study. The subjects were divided into a non-sarcopenic group (n = 12) and a sarcopenic group (n = 23) according to the sarcopenia diagnostic criteria proposed by the Asian Working Group for Sarcopenia. Maximum inspiratory pressure, maximum expiratory pressure, skeletal muscle mass (trunk, upper and lower limbs), and hand grip strength were measured. Pearson’s correlation coefficient and multiple regression analysis were used for statistical processing. Results: In the non-sarcopenic group, both expiratory muscle strength and hand grip strength were correlated with skeletal muscle mass. In the sarcopenia group, expiratory muscle strength was not correlated with skeletal muscle mass, and only hand grip strength was correlated with upper limb muscle mass. Multiple regression analysis revealed that, in the non-sarcopenic group, trunk muscle mass was the primary factor in expiratory muscle strength and upper limb muscle mass was the primary factor in hand grip strength. In the sarcopenia group, upper limb muscle mass was found to be the main factor in hand grip strength. Conclusion: Our results highlight the importance of assessing expiratory muscle strength and trunk muscle mass before sarcopenia develops in older people who require support and nursing care.

Sonographic muscle mass assessment in patients after cardiac surgery

BACKGROUND Patients undergoing cardiac surgery particularly those with comorbidities and frailty,experience frequently higher rates of post-operative morbidity,mortality and prolonged hospital length of stay.Muscle mass wasting seems to play important role in prolonged mechanical ventilation(MV)and consequently in intensive care unit(ICU)and hospital stay.AIM To investigate the clinical value of skeletal muscle mass assessed by ultrasound early after cardiac surgery in terms of duration of MV and ICU length of stay.METHODS In this observational study,we enrolled consecutively all patients,following their admission in the Cardiac Surgery ICU within 24 h of cardiac surgery.Bedside ultrasound scans,for the assessment of quadriceps muscle thickness,were performed at baseline and every 48 h for seven days or until ICU discharge.Muscle strength was also evaluated in parallel,using the Medical Research Council(MRC)scale.RESULTS Of the total 221 patients enrolled,ultrasound scans and muscle strength assessment were finally performed in 165 patients(patients excluded if ICU stay<24 h).The muscle thickness of rectus femoris(RF),was slightly decreased by 2.2%[(95%confidence interval(CI):-0.21 to 0.15),n=9;P=0.729]and the combined muscle thickness of the vastus intermedius(VI)and RF decreased by 3.5%[(95%CI:-0.4 to 0.22),n=9;P=0.530].Patients whose combined VI and RF muscle thickness was below the recorded median values(2.5 cm)on day 1(n=80),stayed longer in the ICU(47±74 h vs 28±45 h,P=0.02)and remained mechanically ventilated more(17±9 h vs 14±9 h,P=0.05).Moreover,patients with MRC score≤48 on day 3(n=7),required prolonged MV support compared to patients with MRC score≥49(n=33),(44±14 h vs 19±9 h,P=0.006)and had a longer duration of extracorporeal circulation was(159±91 min vs 112±71 min,P=0.025).CONCLUSION Skeletal quadriceps muscle thickness assessed by ultrasound shows a trend to a decrease in patients after cardiac surgery post-ICU admission and is associated with prolonged duration of MV and ICU length of stay.

Skeletal muscle loss is associated with diabetes in middle-aged and older Chinese men without non-alcoholic fatty liver disease

BACKGROUND Skeletal muscle,a key insulin target organ,has been reported to be associated with diabetes mellitus(DM).Compared to non-diabetic patients,diabetic patients have decreased muscle mass and a higher prevalence of sarcopenia,and patients with sarcopenia may be at increased risk of developing diabetes.In individuals with nonalcoholic fatty liver disease(NAFLD),sarcopenia is associated with the severity of fibrosis and steatosis.Previous studies have demonstrated that NAFLD is strongly associated with DM and sarcopenia.AIM To determine the relationship between skeletal muscle mass and DM in Chinese middle-aged and elderly men,and whether the association is affected by NAFLD.METHODS Skeletal muscle mass was calculated as appendicular skeletal muscle mass(ASM)in kg/body weight×100%.Liver fat content(LFC)was measured using a quantitative ultrasound method.RESULTS As the ASM decreased,fasting blood glucose(FBG),2-h postprandial blood glucose(2hBG),and LFC increased in both genders,as did the prevalence of DM and NAFLD.Spearman analysis showed that the ASM was negatively correlated with the FBG,2hBG,and LFC.Stepwise logistic regression analysis showed that after adjustments,the ASM quartile was negatively associated with the presence of DM in males,but not in females.Subgroup analysis showed that the ASM quartiles remained negatively correlated with the presence of DM in the non-NAFLD population(including males and females),but no correlation was found between ASM quartiles and the presence of DM in the NAFLD population.When stratified by LFC quartiles,ASM was negatively correlated with the presence of DM in the first and second LFC quartiles in males.CONCLUSION Skeletal muscle mass loss was shown to be associated with the presence of DM in males,but not in females;NAFLD weakens this association.The results suggested that the stratified management of diabetes mellitus should be considered according to skeletal muscle mass and NAFLD.

Effect of resistance exercise on insulin sensitivity of skeletal muscle

Insulin resistance(IR)is the common pathophysiological basis of many metabolic diseases.IR is characterized by decreased glucose uptake in skeletal muscle and adipose tissue,especially in skeletal muscle.Skeletal muscle is the main target tissue of glucose uptake under insulin stimulation.Glucose uptake by skeletal muscle is complex,and it is controlled by many pathways.The PI3K/AKt/GSK-1 signaling pathway is not only the main pathway for insulin signal transduction but also an important mechanism for regulating blood glucose.From the binding of insulin to its receptors on the surface of target cells to the transportation of glucose from extracellular fluid to skeletal muscle,a series of signal transduction processes is completed,any of which potentially affects the physiological effects of insulin and leads to IR.Resistance exercise(RT)can reduce skeletal muscle IR and effectively improve blood glucose control and glycosylated hemoglobin level in patients with type 2 diabetes mellitus(T2DM).However,the exact mechanism by which RT improves skeletal muscle IR remains unclear.Therefore,this paper discusses the above problems by tracking the progress of the literature to deepen the correlation between RT and skeletal muscle insulin sensitivity and provide further evidence for the application of exercise therapy in IR.In conclusion,RT mainly improves insulin sensitivity of skeletal muscle by increasing muscle mass,microvascular blood flow,and glucose transporter-4 expression in skeletal muscle,as well as by reducing lipid accumulation and inflammation in skeletal muscle.Thus,it is potentially useful in the prevention and treatment of T2DM.

IgG4-Related Disease Presenting as a Soft Tissue Tumor Affecting Skeletal Muscle: A Case Report

Background: IgG4-related disease is a systemic lymphoproliferative syndrome that shows IgG4-producing plasma cell expansion in affected organs with fibrotic or sclerotic changes. The lacrimal glands, salivary glands and pancreas are typically affected. We report a case of IgG4-related disease presenting a soft tissue tumor affecting skeletal muscle. Case Report: A 32-year-old man presented a soft tissue mass in his left arm. Magnetic resonance imaging revealed a spindle like, peripheral mass, in the lateral head of the triceps of his left arm. Tru-Cut Biopsy provided the diagnosis of IgG4-related disease affecting skeletal muscle. Glucocorticoid treatment was effective. Conclusion: To our knowledge, this is the first reported case of IgG4-related disease affecting skeletal muscle and presenting a soft tissue mass.

SMI、SI与呼吸危重症患者营养状况及预后的相关性观察

目的分析骨骼肌质量指数(SMI)、肌少症指数(SI)与呼吸危重症营养状况及预后的相关性。方法选取2020年5月至2022年6月在天津市北辰区中医医院接受治疗的呼吸危重患者130例,参照改良危重症营养风险评分表(mNUTRIC)对其营养状态予以测评,比较不同营养状况者SMI、SI水平。通过多因素Logistic回归模型探索呼吸危重症死亡的风险因素,利用受试者工作特征(ROC)曲线明确SMI、SI在呼吸危重症患者死亡风险中的评估价值。结果130例患者中高营养风险48例设为高风险组、低营养风险82例设为低风险组,高风险组SMI、SI低于低风险组(P<0.05)。离开ICU时,本组130例患者中36例死亡设为预后不良组、存活94例设为预后良好组,预后不良组年龄、APACHEⅡ评分及PCT水平高于预后良好组,ALB、SI和SMI则低于预后良好组(P<0.05)。多因素Logistic回归模型分析证实,高APACHEⅡ评分及低SMI、SI值为呼吸危重症病死的独立危险因素(P<0.05)。ROC证实,SMI、SI在呼吸危重症患者死亡预测中的预测AUC 0.890高于单独预测的0.784、0.726(P<0.05)。结论SMI、SI水平与呼吸危重症患者营养状况具有密切关联性,监测两者水平可对疾病病死风险予以预测评估预测患者死亡的临床价值较高。

骨科人工全膝关节置换伴肌少症患者围手术期运动方案的制定和应用效果评价

目的 探究围手术期运动方案的制定和应用对骨科人工全膝关节置换(TKA)伴肌少症患者的影响。方法 选取2023年1—8月郑州大学第一附属医院接受TKA伴肌少症患者98例,根据随机数表法分为对照组和观察组,各49例。对照组采取常规护理,观察组在对照组基础上采取运动护理方案。观察两组康复情况、美国膝关节协会评分(AKS)、身体成分指标[四肢骨骼肌量(ASM)、手握力(HGS)]、恐动心理[简版恐动症评估量表(TSK-11)]。结果 观察组骨折愈合时间与负重时间短于对照组(P>0.05);干预2个月后,观察组AKS评分高于对照组(P<0.05),TSK-11评分低于对照组(P<0.05),ASM、HGS水平高于对照组(P<0.05)。结论 围手术期运动方案的制定和应用能减轻TKA伴肌少症患者恐动心理,改善患者骨骼肌量,加速患者术后康复。

骨骼肌质量指数与老年2型糖尿病患者白蛋白尿的相关性

目的探讨骨骼肌质量指数(SMI)与老年2型糖尿病患者白蛋白尿的相关性。方法选取2020年2月至2022年5月该院肾内科及老年内分泌科收治的年龄大于或等于60岁的老年2型糖尿病患者298例作为研究对象。收集患者病史等一般资料、实验室检查指标等,使用生物电阻抗法测量后计算四肢SMI。根据尿微量白蛋白/肌酐比值(ACR)水平分为正常尿蛋白组(ACR<30 mg/g,135例)、微量白蛋白尿组(ACR 30~300 mg/g,91例)和大量白蛋白尿组(ACR>300 mg/g,72例)。采用χ^(2)检验进行组间比较;采用Spearman秩相关系数分析ACR与SMI的关系,应用多元logistic回归模型进行独立性检验,根据性别生成受试者工作特征曲线寻找SMI影响白蛋白尿的临界(Cut-off)值。结果与正常尿蛋白组比较,微量白蛋白尿组、大量白蛋白尿组患者病程均明显延长,糖化血红蛋白、空腹血糖水平均明显升高,估算肾小球滤过率、SMI均明显降低,差异均有统计学意义(P<0.05);与微量白蛋白尿组比较,大量白蛋白尿组患者病程明显延长,糖化血红蛋白水平明显升高,估算肾小球滤过率、SMI均明显下降,差异均有统计学意义(P<0.05);SMI下降是老年2型糖尿病患者ACR升高的独立危险因素[优势比=1.685,95%可信区间(95%CI)1.078~2.638,P=0.022];蛋白尿大于30 mg/g时受试者工作特征曲线下面积(AUC)为0.717(95%CI 0.554~0.880,P=0.001),SMI的Cut-off值为6.05 kg/m^(2);男性AUC为0.714(95%CI 0.586~0.842,P=0.001),SMI的Cut-off值为7.55 kg/m^(2);女性AUC为0.611(95%CI 0.511~0.711,P=0.033),SMI的Cut-off值为5.85 kg/m^(2)。结论SMI可能是糖尿病肾病进展的独立危险因素,男性SMI<7.55 kg/m^(2)、女性SMI<5.85 kg/m^(2)则发生糖尿病肾病的风险增加。

骨骼肌质量和肌肉力量对缺血性脑卒中患者神经功能的预测效能评价

目的 探讨并评价缺血性脑卒中患者骨骼肌质量和肌肉力量对脑卒中后3个月神经功能预后的预测效能。方法 纳入117例缺血性脑卒中患者,根据脑卒中后3个月的改良Rankin量表(mRS)评分分为预后不良组(54例)和预后良好组(63例),比较两组骨骼肌质量、肌肉力量等相关指标的差异。采用Pearson相关分析骨骼肌质量、肌肉力量与mRS评分之间的相关性,采用logistic回归分析ASM/Ht2、握力与神经功能预后之间的关系,同时应用受试者工作特征(ROC)曲线评估其对神经功能预后的预测效能。结果 与预后良好组相比,预后不良组年龄均数较大、国立卫生研究院脑卒中量表(NIHSS)评分均数较高,合并低肌肉质量的患者比例、合并低肌肉力量的患者比例以及同时合并低肌肉质量与低肌肉力量的患者比例均较高;而ASM/Ht2和握力均数则较低,差异均有统计学意义(t分别=3.55、4.94,χ^(2)分别=7.27、20.35、11.51,t分别=-4.40、-9.56,P均<0.05)。ASM/Ht2、握力与mRS评分呈负相关(r分别=-0.56、-0.74,P均<0.05)。多因素logistic回归分析发现,ASM/Ht2和握力大是神经功能预后不良发生的保护因素(OR分别=0.64、0.54,P均<0.05)。ROC分析显示,握力的曲线下面积(AUC)为0.89,明显大于ASM/Ht2的AUC(0.71),差异有统计学意义(Z=3.05,P<0.05)。结论 脑卒中患者发病早期的骨骼肌质量和肌肉力量均与其康复期神经功能不良预后密切相关。骨骼肌质量和肌肉力量对脑卒中患者神经功能预后均具有较好的预测价值,尤其是握力,其预测效能更优。

Is there any correlation between Iiver graft regeneration and recipient's pretransplant skeletal muscle mass?-a study in extended Ieft Iobe graft Iiving-donor Iiver transplantation

Background:The end-stage liver disease causes a metabolic dysfunction whose most prominent clinical feature is the loss of skeletal muscle mass(SMM).In living-donor liver transplantation(LDLT),liver graft regeneration(GR)represents a crucial process to normalize the portal hypertension and to meet the metabolic demand of the recipient.Limited data are available on the correlation between pre-LDLT low SMM and GR.Methods:Retrospective study on a cohort of 106 LDLT patients receiving an extended left liver lobe graft.The skeletal muscle index(SMI)at L3 level was used for muscle mass measurement,and the recommended cut-off values of the Japanese Society of Hepatology guidelines were used as criteria for defining low muscularity.GR was evaluated as rate of volume increase at 1 month post-LT[graft regeneration rate(GRR)].Results:The median GRR at 1 month post-LT was 91%(IQR,65-128%)and a significant correlation with graft volume-to-recipient standard liver volume ratio(GV/SLV)(rho-0.467,P<0.001),graft-to-recipient weight ratio(GRWR)(rho-0.414,P<0.001),donor age(rho-0.306,P=0.001),1 month post-LT cholinesterase serum levels(rho 0.397,P=0.002)and pre-LT low muscularity[absent vs.present GRR 97.5%(73.1-130%)vs.83.5%(45.2-110.9%),P=0.041]was noted.Moreover in male recipients,but not in women,it was shown a direct correlation with pre-LT SMI(rho 0.352,P=0.020)and inverse correlation with 1 month post-LT SMI variation(rho-0.301,P=0.049).A low GRR was identified as an independent prognostic factor for recipient overall survival(HR 6.045,P<0.001).Conclusions:Additionally to the hemodynamic factors of portal circulation and the quality of the graft,the metabolic status of the recipients has a significant role in the GR process.A pre-LT low SMM is associated with impaired GRR and this negative impact is more evident in male recipients.

生物电阻抗法测量18~42岁成人四肢骨骼肌质量的准确性评价

目的评价生物电阻抗法(bioelectrical impedance analysis,BIA)测量成人四肢骨骼肌质量(appendicular skeletal muscle mass,ASM)的准确性。方法采用方便抽样法,于2021年4月至2022年9月在广州全市招募836名18~42岁成人,采用BIA与双能X线吸收法(dual-energy X-ray absorptiometry,DXA)同步检测ASM。以DXA为标准方法,通过组内相关系数以及在对数变换数据中进行Bland-Altman分析判断BIA与DXA所测值的一致性,以此评价BIA测量ASM的准确性。绘制受试者工作特征曲线,评价BIA识别低肌肉质量的诊断价值。结果最终纳入774名研究对象。男、女性中两法所测ASM组内相关系数分别为0.774和0.667。男、女性中BIA与DXA所测ASM比值均值(一致性限)分别为0.94(0.80~1.10)和0.91(0.78~1.05)。BIA识别男、女性低肌肉质量的曲线下面积分别0.91和0.94。BIA判断男、女性低肌肉质量的Z值最佳界值分别为-0.57和-0.66,男性中BIA识别低肌肉质量的灵敏度、特异度分别为82.5%、86.0%,女性中分别为86.8%、93.8%。结论BIA与DXA所测成人四肢骨骼肌质量的一致性尚可,且BIA识别18~42岁成人低肌肉质量的诊断价值较好。

骨骼肌质量指数、肌少症指数与呼吸危重症患者营养状态及预后的关系分析

目的探讨骨骼肌质量指数(Skeletal muscle mass index,SMI)、肌少症指数(Sarcope-nia index,SI)与呼吸危重症患者营养状态及预后的关系。方法选取2021年9月至2023年8月南通市第一人民医院收治的呼吸危重患者132例。采用改良危重症营养风险评分表(The modi-fied nutrition risk in critically ill,mNUTRIC)评估患者营养状况,根据评分结果分为低风险患者(n=83)、高风险患者(n=49),比较低风险患者与高风险患者的SMI、SI。以离开ICU为时间终点评估预后,分为死亡组(n=37)和存活组(n=95),比较死亡组与存活组患者的一般资料,采用多因素Logistic回归模型分析影响呼吸危重症患者死亡的因素,受试者工作特征(Receiver operator characteristic,ROC)曲线分析SMI、SI预测呼吸危重症患者死亡的风险价值。结果与低风险患者相比,高风险患者的SMI、SI降低(P<0.05)。以离开重症监护室(Intensive care unit,ICU)为评估时间终点,与存活组相比,死亡组年龄、入院24 h内的急性生理评分、年龄评分及慢性健康评分(Acute physiology and chronic health evaluation scoring system,APACHEⅡ)评分及降钙素原(Procalcitonin,PCT)水平较高,白蛋白(Albumin,ALB)、SI和SMI则较低(P<0.05)。多因素Logistic回归模型显示,高APACHEⅡ评分及低SMI、SI值是影响呼吸危重症死亡的独立危险因素。ROC曲线显示,SMI、SI单独预测呼吸危重症患者死亡的曲线下面积(Area under curve,AUC)为0.784(0.720~0.839)、0.726(0.657~0.788),采用SMI、SI联合预测AUC为0.890(0.835~0.938),联合预测效能较单独预测效能更好(P<0.05)。结论SMI、SI与呼吸危重症患者营养状态关系密切,两者联合预测呼吸危重症患者死亡的临床价值高于单独预测。