第三腰椎骨骼肌指数、腰大肌指数对肝硬化腹水患者营养及预后的评估价值  

The role of the skeletal muscle index and psoas major muscle index taken at the third lumbar vertebra level in the evaluation on the nutritional status and prognosis of cirrhosis patients with ascites

作　　者：尚杰[1] 郭银燕[1] 庆琳琳 赵晓志[1] 张晓 常显星 Shang Jie;Guo Yinyan;Qing Linlin;Zhao Xiaozhi;Zhang Xiao;Chang Xianxing(Department of Gastroenterology,Beijing Haidian Hospital,Beijing 100080,China)

机构地区：[1]北京市海淀医院消化科,北京100080

出　　处：《中华临床营养杂志》2024年第2期113-116,共4页Chinese Journal of Clinical Nutrition

摘　　要：目的探讨第三腰椎骨骼肌指数(the third lumbar skeletal muscle index,L3-SMI)、第三腰椎腰大肌指数(the third lumbar psoas muscle index,L3-PMI)在肝硬化腹水患者营养及预后评估中的价值。方法回顾性分析2018年9月至2022年9月北京市海淀医院消化内科就诊肝硬化腹水患者102例的临床资料,测量患者第三腰椎骨骼肌、腰大肌面积,并计算L3-SMI、L3-PMI,根据L3-SMI划分为肌量减少组(62例)和肌量正常组(40例)。观察比较两组L3-SMI、L3-PMI、体重指数(body mass index,BMI)、白蛋白及随访期间再入院次数、死亡率,评价各指标在营养评估中的价值。结果肝硬化腹水肌量减少组患者L3-SMI、L3-PMI、白蛋白显著低于肌量正常组,差异有统计学意义(P<0.01)。肌量减少组BMI低于肌量正常组,但差异无统计学意义(P>0.05)。L3-PMI与白蛋白、BMI相比具有更好的营养评估价值。肌量减少组随访期间再住院次数、死亡率显著高于肌量正常组,差异有统计学意义(P<0.05)。结论L3-SMI、L3-PMI可有效反映肝硬化腹水患者的营养状态,对肝硬化腹水患者预后具有较好的评估价值。Objective To evaluate the value of the skeletal muscle index(SMI)and psoas major muscle index(PMI)measured at the third lumbar vertebra(L3)level in the evaluation on nutritional status and prognosis of cirrhosis patients with ascites.Methods The clinical data of 102 patients with cirrhosis and ascites treated in our department between September 2018 and September 2022 was analyzed retrospectively,the skeletal muscle and psoas muscle area at L3 level were measured,and L3-SMI and L3-PMI were calculated.According to L3-SMI,patients were divided into the sarcopenia group(62 cases)and the normal muscle mass group(40 cases).Differences between the two groups were compared in terms of L3-SMI,L3-PMI,body mass index(BMI),albumin,the rate of re-admissions and mortality during follow-up.The value of each index in nutritional assessment was also explored.Results L3-SMI,L3-PMI,and albumin in the sarcopenia group were significantly lower than those in the normal muscle mass group,with statistical significance(P<0.01).The BMI of the sarcopenia group was lower than that of the normal muscle mass group,but the difference was not significant(P>0.05).L3-PMI showed better performance in nutritional assessment compared with albumin and BMI.The rate of re-admissions and the mortality rate in the sarcopenia group during the follow-up period were significantly higher compared with the normal muscle mass group(P<0.05).Conclusion L3-SMI and L3-PMI can effectively reflect the nutritional status of cirrhosis patients with ascites,and are promising indicators for prognosis prediction in cirrhosis patients with ascites.

关 键 词：第三腰椎骨骼肌指数 第三腰椎腰大肌指数 肝硬化腹水 营养 预后 

分 类 号：R575.2[医药卫生—消化系统] R459.3[医药卫生—内科学]