慢性肾病患者L3椎体水平肌肉质量评估  

Evaluation of Muscle Quality in Patients with Chronic Kidney Disease Based on CT at the Level of Lumbar 3 Vertebral.

作　　者：和建伟[1] 马小梅[1] 曹剑仓 惠敏敏 张莉娜 王平[1] He Jianwei;Ma Xiaomei;Cao Jiancang(Department of Radiology,Gansu Provincial People's Hospital,Lanzhou,Gansu 730013,China.)

机构地区：[1]甘肃省人民医院放射科,甘肃兰州730013 [2]甘肃省中医药大学,甘肃兰州730030

出　　处：《四川医学》2024年第10期1067-1072,共6页Sichuan Medical Journal

基　　金：甘肃省青年科技基金计划(编号:21JR7RA639);甘肃省人民医院院内基金项目(编号:21GSSYB-20)。

摘　　要：目的通过测量不同临床分期慢性肾病(CKD)患者的L3椎体水平腰大肌及棘旁肌的面积及密度,以评价L3椎体水平肌肉质量对CKD患者营养状态的评估价值。方法回顾性收集2023年2月至10月我院193例CKD患者的影像及临床资料,分别勾画并测量L3水平腰大肌及棘旁肌的面积(PMA、PSMA)及密度(PMD、PSMD),计算出腰大肌指数(PMI)及棘旁肌指数(PSMI)。根据估算肾小球滤过率(eGFR),划分CKD患者临床分期。分析不同临床分期CKD患者肌肉质量(即腰大肌及棘旁肌的面积)的差异。结果不同临床分期,男性患者的腰大肌及棘旁肌的面积均高于女性,差异有统计学意义,密度差异无统计学意义;且随着年龄的增高,腰大肌及棘旁肌的面积缩小,PMI及PSMI降低;CKD 4~5期患者的腰大肌及棘旁肌面积较CKD 1~3期患者明显降低,且差异有统计学意义(P<0.05),CKD 1~3期之间及4~5期之间患者的肌肉质量差异不大。结论随着临床分期的增加,CKD患者L3椎体水平肌肉的面积呈下降趋势,且肌肉密度CT值逐渐减低,尤其4~5期的患者较1~3期明显减低。Objective The area and density of the psoas major and paraspinalis muscles at the lumbar 3(L3)vertebrae level in patients with chronic kidney disease(CKD)at different clinical stages were measured to evaluate the value of L3 vertebrae muscle mass in evaluating the nutritional status of patients with CKD.Methods Imaging and clinical data of 193 patients with CKD were retrospectively collected.The area and density of psoas muscles and paraspinous muscles(PMA,PSMA,PMD,PSMD)at L3 level were delineated and measured.Psoas muscle index(PMI)and paraspinous muscle index(PSMI)were calculated.According to estimated glomerular filtration rate(eGFR),CKD patients were divided into clinical stages,and the differences in muscle mass of CKD patients in different clinical stages were analyzed.Results CKD patients with different clinical stages,the area of psoas major and paraspinous muscle of male patients was higher than that of female patients,the difference was statistically significant,but the density difference was not statistically significant.With the increase of age,the area of psoas major and paraspinous muscle decreased,and PMI and PSMI decreased.The area of psoas major and paraspinous muscle in CKD 4~5 patients was significantly reduced compared with that in CKD 1~3 patients,and the difference was statistically significant(P<0.05).There was no significant difference in muscle mass between CKD 1~3 and 4~5 patients.Conclusion There is a certain correlation between L3 vertebral level muscle mass and clinical stage in patients with CKD,which has a certain significance for evaluating the nutritional status of patients.

关 键 词：慢性肾病 腰大肌 棘旁肌 肌肉质量 CT 

分 类 号：R445.3[医药卫生—影像医学与核医学]