CT相关骨骼肌参数对肝细胞癌患者肝移植后存活率的影响

Impact of CT-relevant skeletal muscle parameters on post-liver transplantation survival in patients with hepatocellular carcinoma

Hepatology International

影响因子:6.1

分区:医学1区 Top / 胃肠肝病学2区

发表日期:2024 Oct

作者: Zhaoxian Li, Yumeng Zhao, Yan Xie, Li Zhang, Yanyan Sun, Kai Yang, Shaoxian Duan, Xinghui Yu, Zhongyang Shen, Wentao Jiang

DOI: 10.1007/s12072-024-10708-z

摘要

肝移植（LT）患者中，预测术后存活的CT相关骨骼肌参数尚不明确。越来越多的证据支持脂肪酸及其脂质中间产物在调节骨骼肌质量和功能中的作用，但脂蛋白亚裂层与体组成关系尚不清楚。回顾性分析2015年1月至2022年9月接受肝移植的HCC患者。评估术前的CT参数，包括骨骼肌指数（SMI）、腰肌指数（PMI）、骨骼肌密度（SMD）、内脏脂肪和皮下脂肪（VAT和SAT）以及在L3水平的VAT/SAT比值，以及血脂谱。284例肝移植患者中，有224例在移植前3个月内进行了L3水平的CT扫描，其中82例（37%）被诊断为肌脂沉积症（myosteatosis）。肌脂沉积症患者的1年及3年存活率明显较低（p=0.002，p=0.01），这一趋势甚至在米兰标准（Milan criteria）之外依然存在（p=0.004，p=0.04）。调整协变量后，SMD与术后存活显著负相关（HR：0.90，[95%置信区间：0.83-0.98]，C统计量：0.78，p=0.009）。Pearson相关分析显示，高密度脂蛋白胆固醇（HDL-C）和载脂蛋白A1（ApoA1）水平与SMD呈正相关。多变量逐步回归分析表明，每降低10个Hounsfield单位的SMD，HDL-C会下降0.16 mmol/L，ApoA1下降0.18 g/L。术前常规腹部CT扫描评估骨骼肌密度与术后死亡显著相关。此外，术前异常的HDL-C及ApoA1水平也与肌脂沉积症相关。

Abstract

The specific CT-related skeletal muscle parameters predictive of postoperative survival in liver transplant (LT) patients with hepatocellular carcinoma (HCC) remain unclear. There is increasing evidence supporting the role of fatty acids and their lipid intermediates in regulating skeletal muscle mass and function, the relationship between lipoprotein subfractions and body composition remains unclear.Adult patients with HCC who underwent LT between January 2015 and September 2022 were retrospectively analyzed. CT parameters, including skeletal muscle index (SMI), psoas muscle index (PMI), skeletal muscle density (SMD), visceral and subcutaneous adipose tissue (VAT and SAT), and the VAT/SAT ratio at the L3 level, and lipid profiles, were assessed prior to LT.Of the 284 LT patients with HCC, 224 underwent CT (L3 level) within 3 months of LT, and 82 (37%) were diagnosed with myosteatosis. Patients with myosteatosis exhibited significantly lower 1- and 3-year survival rates (p = 0.002, p = 0.01), a trend persisting even beyond the Milan criteria (p = 0.004, p = 0.04). After adjusting for covariates, SMD demonstrated a significant negative correlation with post-transplant survival (HR: 0.90, [95% Confidence Interval(CI): 0.83-0.98], C-statistic: 0.78, p = 0.009). Pearson's correlation analysis revealed a positive correlation between high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1(ApoA1) levels and SMD. Multivariate stepwise regression analysis demonstrated that every 10 Hounsfield unit decrease in SMD was associated with a 0.16 mmol/L decrease in HDL-C and a 0.18 g/L decrease in ApoA1.Routine abdominal CT scans for assessing skeletal muscle density before LT were significantly associated with post-transplant mortality. Furthermore, abnormal HDL-C and ApoA1 levels before LT were associated with myosteatosis.