腰大肌主要指数联合上臂围在肝硬化合并肌少症患者中的诊断价值

摘要/Abstract

摘要： 目的评价腰大肌主要指数联合营养评估在肝硬化合并肌少症患者中的诊断价值。方法共收集新疆维吾尔自治区中医医院诊断为肝硬化的患者215例;以第三腰椎水平骨骼肌指数(L3-SMI)＜50 cm²/m²(男性)或＜39 cm²/m²(女性)为诊断标准,将患者分为肌少症组与非肌少症组进行组间比较;接着绘制ROC,根据AUC判断营养评估指标、CT影像指标的诊断效能。结果肌少症和非肌少症组患者的血清学指标及肝功能比较,年龄、RBC计数、HGB差异有统计学意义(P<0.05);肌少症组患者营养评分高于非肌少症组,且肌少症组TSF、AMC、上臂围、小腿围、SMI、PMI、腰大肌面积均低于非肌少症组,差异均有统计学意义(P<0.05)。在肝硬化合并肌少症患者中,上臂围具有较高的诊断价值,男性AUC=0.769(95%CI 0.676～0.861),截断值为28.25 cm,女性AUC=0.789(95%CI 0.688～0.889),截断值为29.50 cm。肝硬化合并肌少症的CT影像诊断评估中AUC由高到低依次为:PMI、腰大肌面积、APMI及腰大肌轴径,男性分别为0.732(95%CI 0.629～0.835)、0.694(95%CI 0.587～0.802)、0.640(95%CI 0.522～0.757)、0.611(95%CI 0.494～0.727);女性分别为0.692(95%CI 0.574～0.810)、0.685(95%CI 0.571～0.799)、0.530(95%CI 0.409～0.650)、0.544(95%CI 0.425～0.662)。其中PMI截断值为:男性7.41 cm²/m²,女性4.64 cm²/m²。腰大肌主要指数联合上臂围的AUC更高,男性为0.824(95%CI 0.745～0.903),女性为0.833(95%CI 0.745～0.921)。结论腰大肌主要指数可以作为肝硬化合并肌少症患者临床评估工具之一;腰大肌主要指数联合上臂围诊断价值更高。

关键词: 腰大肌主要指数, 上臂围, 肝硬化, 肌少症

Abstract: Objective To evaluate the diagnostic value of the psoas muscle index combined with nutritional assessment in patients with cirrhosis and sarcopenia. Methods The clinical data of 215 patients diagnosed with cirrhosis in Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region were collected. Using skeletal muscle index (SMI) of the third lumbar spine (L3) (male < 50 cm²/m² or female < 39 cm²/m²) as the diagnostic criterion, patients were divided into sarcopenia and non-sarcopenia groups for intergroup comparisons. The receiver operating characteristic curve (ROC) was plotted, and the area under the curve (AUC) was used to determined the diagnostic value of nutritional assessment indicators, and CT imaging indicators. Methods (1) According to comparison results of serological indexes and liver function between patients in sarcopenia and non-sarcopenia groups, the differences in age, RBC count, and HGB were statistically significant (P<0.05). The nutritional scores of patients in sarcopenia group were higher than those in non-sarcopenia group. The TSF, AMC, upper arm circumference, calf circumference, SMI, PMI, and psoas muscle area of patients in sarcopenia group were lower than those of patients in non-sarcopenia group, and the differences were all statistically significant (P<0.05). (2) In patients with cirrhosis and sarcopenia, upper arm circumference had a high diagnostic value, with the AUC=0.769 (95% CI: 0.676～0.861) and a cutoff value of 28.25 cm for men, and the AUC=0.789 (95% CI: 0.688～0.889) and a cutoff value of 29.50 cm for women. (3) In the AUC of CT imaging diagnostic evaluation indicators for liver cirrhosis with muscular dystrophy, the order from high to low is: PMI, psoas muscle area, APMI and axis diameter psoas muscle, which were 0.732 (95% CI 0.629～0.835), 0.694 (95% CI 0.587～0.802), 0.640(95% CI 0.522～0.757), and 0.611 (95% CI 0.494～0.727) for male; and 0.692 (95% CI 0.574～0.810), 0.685 (95% CI 0.571～0.799), 0.530 (95% CI 0.409～0.650), and 0.544 (95% CI 0.425～0.662) for female, respectively. The cutoff values of PMI were 7.41 cm²/m² for male and 4.64 cm²/m² for female.(4) The AUC of the psoas muscle index combined with upper arm circumference was higher with a value of 0.824 (95% CI 0.745～0.903) for male, and 0.833 (95% CI 0.745～0.921) for female. Conclusion The psoas muscle index can be used as one of the clinical evaluation tools in patients with cirrhosis and sarcopenia. The psoas muscle index combined with arm circumference has a higher diagnostic value.

Key words: Psoas muscle index, Arm circumference, Cirrhosis, Sarcopenia

余虹, 敬进华, 古再努尔·依力亚尔, 孙微, 窦婧宁忠慧, 徐强, 王晓波, 王转国, 王晓忠, 蒋弈, 郭峰. 腰大肌主要指数联合上臂围在肝硬化合并肌少症患者中的诊断价值[J]. 肝脏, 2025, 30(1): 65-73.

YU Hong, JING Jin-hua, GUZAINUR Yiliar, SUN Wei, DOU Jing, NING Zhong-hui, XU Qiang, WANG Xiao-bo, WANG Zhuan-guo, WANG Xiao-zhong, JIANG Yi, GUO Feng. The diagnostic value of the psoas muscle index combined with arm circumference in patients with cirrhosis and sarcopenia[J]. Chinese Hepatolgy, 2025, 30(1): 65-73.

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