骨骼肌低脂肪组织浸润是透析患者全因死亡的保护性表型

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-08-05 DOI:10.1016/j.clnu.2025.07.028

Jing Zheng , Shi-yuan Wang , Guo-hao Zheng , Jian Zhang , Shi-mei Hou , Yu-nuo Li , Li Tian , Li Yuan , Dong-yang Yin , Hui-min Chen , Min Li , Yao Wang , Jing-yuan Cao , Yan-zhi Li , Jing-jie Xiao , Min Yang , Xiao-liang Zhang , Bi-Cheng Liu , Bin Wang

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引用次数: 0

摘要

背景,aimsA新开发的低衰减肌肉指数（LAMI）反映了低衰减肌肉中脂肪组织浸润程度与CT图像上骨骼肌质量的关系。我们研究了ct衍生的LAMI与第一腰椎横突（L1）低衰减肌肉面积与骨骼肌面积之比（LAMA/SMA）与透析患者全因死亡之间的关系。方法回顾性队列研究纳入2014年1月1日至2020年6月30日首次透析患者。记录的全因死亡终点截止到2022年12月31日。根据基于性别的LAMI临界值将患者分为低LAMI组（n = 408）和高LAMI组（n = 425）。比较两组患者的基线临床数据、ct衍生参数、生存率和生存时间。采用限制三次样条分别探讨男性和女性LAMI与全因死亡之间的关系。采用多因素Cox回归分析和逐步Cox回归分析分析LAMI与全因死亡的相关性。结果共纳入833例患者，其中男性536例，占64.35%。中位随访时间为3.86年（范围0-9.11），225例（27.01%）患者在随访期间死亡。低lami组低衰减肌肉放射密度[6.35(4.33,7.67)HU vs. 7.58(6.06,8.92)HU]和LAMA/SMA比值[0.35(0.27,0.44)vs. 0.43(0.34, 0.51)]显著低于高lami组，但骨骼肌放射密度（41.50 [7.09]HU vs. 29.60 [7.46]HU）显著高于高lami组(P <；0.001)。此外，该组的全因死亡发生率显著低于对照组（20.3%比33.4%），生存时间显著长于对照组（50.97[24.98]个月比44.90[23.92]个月）(P <；0.001)。根据基于性别的受限三次样条模型，LAMI与男性和女性全因死亡之间存在线性关系(均为非线性P >；0.05)。多因素Cox回归分析和逐步Cox回归分析显示，低LAMI和低LAMA/SMA比值均是透析患者全因死亡的独立保护因素(P <；0.01)。结论骨骼肌脂肪组织浸润并不一定是透析患者的有害表型，当其区域相对局限时。

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Low adipose tissue infiltration in skeletal muscle is a protective phenotype of all-cause death in patients undergoing dialysis

Background & aims

A newly developed low-attenuation muscle index (LAMI) reflects the relationship of the degree of adipose tissue infiltration in low-attenuation muscle and the skeletal muscle quality on computed tomography (CT) images. We investigated the relationship between CT-derived LAMI and ratio of low-attenuation muscle area to skeletal muscle area (LAMA/SMA) at transverse process of the first lumbar vertebra (L1) and all-cause death in dialysis patients.

Methods

This retrospective cohort study of initial-dialysis patients enrolled from January 1, 2014, to June 30, 2020. The endpoint of all-cause death was recorded up to December 31, 2022. Patients were divided into low- (n = 408) and high- (n = 425) LAMI groups according to the sex-based LAMI cutoff value. Baseline clinical data, CT-derived parameters, survival rates and survival times were compared between the two groups. Restricted cubic spline was used to explore the relationships between LAMI and all-cause death separately for men and women. Multivariate Cox regression analysis and stepwise Cox regression analysis were used to analyze the association between LAMI and all-cause death.

Results

A total of 833 patients were eligible to analysis, and 536 (64.35 %) patients were male. The median follow-up time was 3.86 years (range, 0–9.11), and 225 (27.01 %) patients died during follow-up period. The low-LAMI group exhibited significantly lower low-attenuation muscle radiodensity [6.35(4.33,7.67)HU vs. 7.58(6.06,8.92)HU] and LAMA/SMA ratio [0.35(0.27,0.44) vs. 0.43(0.34, 0.51)], yet significantly greater skeletal muscle radiodensity (41.50 [7.09]HU vs. 29.60 [7.46]HU) compared to the high-LAMI group (all P < 0.001). Additionally, this group had a significantly lower incidence of all-cause death (20.3 % vs. 33.4 %) and significantly longer survival time (50.97[24.98]months vs. 44.90[23.92]months) (both P < 0.001). According to the sex-based restricted cubic spline models, linear relationships between LAMI and all-cause death were found for men and women (both nonlinear P > 0.05). Multivariate Cox regression analysis and stepwise Cox regression analysis revealed that a low LAMI and a low LAMA/SMA ratio were both independent protective factors of all-cause death in dialysis patients (all P < 0.01).

Conclusions

Adipose tissue infiltration in skeletal muscle is not always a harmful phenotype for dialysis patients, when its area is relatively localized.

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.