CT相关的骨骼肌参数对肝细胞癌患者的肝移植后存活的影响
Impact of CT-relevant skeletal muscle parameters on post-liver transplantation survival in patients with hepatocellular carcinoma
影响因子:6.10000
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
摘要
特定的与CT相关的骨骼肌参数可预测肝移植（LT）肝细胞癌（HCC）患者的术后存活率（HCC）尚不清楚。越来越多的证据支持脂肪酸及其脂质中间体在调节骨骼肌质量和功能中的作用，脂蛋白亚段与身体成分之间的关系仍然不清楚。在2015年1月至2022年9月之间接受LT的HCC患者进行了回顾性分析。 CT参数，包括骨骼肌指数（SMI），PSOAS肌肉指数（PMI），骨骼肌密度（SMD），内脏和皮下脂肪组织（VAT和SAT）以及L3水平的VAT/SAT/SAT/SAT/SAT/SAT/SAT/SAT的比例，以及脂质概况的评估，并在LT.284 lt中进行评估。 3个月的LT和82（37％）被诊断出患有肌萎缩症。 Myosteatosis的患者表现出明显降低的1年和3年生存率（P = 0.002，P = 0.01），甚至超出了米兰标准（P = 0.004，p = 0.04）的趋势持续存在。调整协变量后，SMD表现出与移植后存活率显着的负相关性（HR：0.90，[95％置信区间（CI）：0.83-0.98]，C-Statistic：0.78，p = 0.009）。皮尔逊的相关性分析表明，高密度脂蛋白胆固醇（HDL-C）和载脂蛋白A1（APOA1）水平与SMD之间存在正相关。多元逐步回归分析表明，SMD中的每10个Hounsfield单位下降每次下降与HDL-C的0.16 mmol/L降低有关，而APOA1的apoA1.Routine腹部CT扫描降低0.18 g/l，以评估LT之前LT的骨骼肌密度显着相关。此外，LT之前的HDL-C和APOA1水平异常与肌萎缩症相关。
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.