初始维持性血液透析合并心血管疾病患者CT图像肌肉质量特征分析  

Analysis of the muscle mass characteristics of CT images in patients on initial maintenance hemodialysis with cardiovascular disease

作　　者：袁莉 曹婧媛 王梅 韦康 廖小胖 张亦儒 王垚[1] 杨明 YUAN Li;CAO Jing-yuan;WANG Mei;WEI Kang;LIAO Xiao-pang;ZHANG Yi-ru;WANG Yao;YANG Ming(Affiliated Hospital of Yangzhou University,Yangzhou 225001,China;不详)

机构地区：[1]扬州大学附属医院肾内科,江苏扬州225001 [2]南京医科大学附属泰州人民医院肾内科,江苏泰州225300 [3]锡山人民医院肾内科,江苏无锡214105 [4]东部战区总医院秦淮医疗区急诊科,江苏南京210000

出　　处：《中国实用内科杂志》2024年第6期484-490,共7页Chinese Journal of Practical Internal Medicine

基　　金：江苏省扬州市科技发展计划项目(SSF2022000036);扬州大学医学创新转化专项基金项目(AHYZUZHXM202105)。

摘　　要：目的 评估初始维持性血液透析(MHD)患者心血管疾病(CVD)与肌肉质量的相关性。方法 回顾性纳入扬州大学附属医院2014年1月至2019年12月收治的116例初始MHD患者,根据病史及相关辅助检查分为MHD合并CVD组(62例)、MHD不合并CVD组(54例)。收集临床及影像学资料,测定及计算骨骼肌密度(SMD)、骨骼肌指数(SMI)、NAMA/TAMA指数、IMAT/TAMA指数。分析评估MHD合并CVD与肌肉质量相关指标的相关性。结果 与MHD不合并CVD组相比,MHD合并CVD组患者的高血压、糖尿病病史比例、年龄、血尿酸水平均较高(P均<0.05)。MHD合并CVD组中SMD(t=-3.104,P=0.002)、NAMA/TAMA指数(t=-3.887,P<0.001)较低,IMAT/TAMA指数(Z=-3.647,P<0.001)较高,两组SMI差异无统计学意义(Z=-0.039,P=0.969)。采用多元Logistic回归分析校正年龄、高血压、糖尿病病史等混杂因素后发现,低NAMA/TAMA指数、低SMD与MHD患者合并CVD风险独立相关,低IMAT/TAMA指数是MHD患者合并CVD的保护因素。结论 MHD合并CVD患者容易伴有肌肉质量下降,CT测量L1横突水平层面NAMA/TAMA指数可用于评价MHD患者肌肉质量,且与其伴发CVD独立相关。Objective To assess the correlation between cardiovascular disease(CVD) and muscle mass in patients on initial maintenance hemodialysis(MHD). Methods A total of 116 patients on initial MHD from January 2014 to December2019 at the Affiliated Hospital of Yangzhou University were included and divided into MHD with CVD group(62 cases)and MHD without CVD group(54 cases)according to their medical history and corresponding ancillary examinations. Clinical and imaging data were collected,and skeletal muscle density(SMD),skeletal muscle index(SMI),NAMA/TAMA index,and IMAT/TAMA index were calculated. The correlation between MHD combined with CVD and muscle mass-related indexes was analyzed and assessed. Results Compared with the MHD patients without CVD,the proportion of hypertension and diabetes,age,and blood uric acid level were higher in the MHD patients with CVD(all P < 0.05). In the MHD with CVD group,SMD(t =-3.104,P = 0.002)and NAMA/TAMA index(t =-3.887,P < 0.001)were lower,while IMAT/TAMA index(z =-3.647,P < 0.001)was higher,but SMI(Z=-0.039,P=0.969)was not significantly different.After adjusting for confounders such as age,hypertension and diabetes,multivariate logistic regression analysis showed that independently associated with the risk of MHD patients with CVD,and low IMAT/TAMA index was an independent protective factor of MHD patients with CVD. Conclusion MHD patients with CVD are prone to decreased muscle mass,and NAMA/TAMA index at the level of L1 transverse process measured by CT can be used to evaluate muscle mass in MHD patients,and is independently associated with MHD patients with CVD.

关 键 词：肌脂肪变性 维持性血液透析 计算机断层扫描 心血管疾病 

分 类 号：R459.5[医药卫生—治疗学]