接受颈动脉内膜剥脱术的无症状患者颈部肌肉质量和品质、全身炎症与存活率之间的关系。

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae114
Nicholas A Bradley, Karamonique Dosanj, Sharon Yen Ming Chan, Alasdair Wilson, Tamim Siddiqui, Rachel Forsythe, Campbell S D Roxburgh, Donlad C McMillan, Graeme J K Guthrie
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引用次数: 0

摘要

背景:肌肉疏松症似乎与手术效果不佳有关。慢性全身炎症导致心血管疾病的长期预后较差,并与肌肉疏松症的发生有关。本研究旨在描述使用计算机断层扫描(CT)得出的身体成分分析和全身炎症评估的肌肉疏松症在因症状性颈动脉狭窄而接受颈动脉内膜切除术的患者中的预后作用:在这项回顾性队列研究中,纳入了2011年1月1日至2021年10月1日期间在四个转诊中心接受颈动脉内膜切除术治疗症状性颈动脉狭窄的患者。术前 CT 图像记录了 C3 骨骼肌指数和 C3 骨骼肌密度。全身炎症采用术前全身炎症分级(SIG)进行评估。主要结果是研究期间的总死亡率:共纳入 618 名患者,中位随访时间为 69 个月(四分位间范围为 34-85 个月)。在单变量分析中,年龄大于或等于 75 岁(P < 0.001)、美国麻醉医师协会(ASA)分级大于 II 级(P < 0.001)、低 C3 骨骼肌指数(P = 0.002)、低 C3 骨骼肌密度(P < 0.001)、SIG大于或等于2(P < 0.001)和低L3衍生骨骼肌指数(P < 0.001)与死亡率增加有关,而体重指数大于或等于25 kg/m2与死亡率降低有关(P = 0.023)。在多变量分析中,75 岁或以上(HR 2.17 (95% c.i. 1.58 to 2.97),P < 0.001)、ASA 分级大于 II(HR 2.06 (95% c.i. 1.35 to 3.12),P < 0.001)、C3 骨骼肌密度低(HR 1.84 (95% c.i. 1.33 to 2.54), P < 0.001)和SIG大于或等于2 (HR 1.63 (95% c.i. 1.33 to 1.99), P < 0.001)与死亡率增加独立相关:结论:颈椎 CT 导出的肌肉质量和密度以及全身炎症标志物(如全身炎症分级)可能与颈动脉内膜剥脱术后较差的长期预后有关。
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Relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy.

Background: Sarcopenia appears to be associated with inferior outcomes in surgical conditions. Chronic systemic inflammation confers an inferior long-term prognosis in cardiovascular disease and is associated with the development of sarcopenia. The aim of this study was to describe the prognostic role of sarcopenia assessed using computed tomography (CT)-derived body composition analysis and systemic inflammation in patients undergoing carotid endarterectomy for symptomatic carotid stenosis.

Methods: In this retrospective cohort study, patients undergoing carotid endarterectomy for symptomatic carotid stenosis between 1 January 2011 and 1 October 2021 at four referral centres were included. The C3 skeletal muscle index and C3 skeletal muscle density were recorded from preoperative CT images. Systemic inflammation was assessed using the preoperative systemic inflammatory grade (SIG). The primary outcome was overall mortality during the study interval.

Results: A total of 618 patients were included, with a median follow-up of 69 (interquartile range 34-85) months. On univariable analysis, age greater than or equal to 75 years (P < 0.001), American Society of Anesthesiologists (ASA) grade greater than II (P < 0.001), low C3 skeletal muscle index (P = 0.002), low C3 skeletal muscle density (P < 0.001), SIG greater than or equal to 2 (P < 0.001), and low L3 derived skeletal muscle index (P < 0.001) were associated with increased mortality, whereas body mass index greater than or equal to 25 kg/m2 was associated with decreased mortality (P = 0.023). On multivariable analysis, age 75 years or older (HR 2.17 (95% c.i. 1.58 to 2.97), P < 0.001), ASA grade greater than II (HR 2.06 (95% c.i. 1.35 to 3.12), P < 0.001), low C3 skeletal muscle density (HR 1.84 (95% c.i. 1.33 to 2.54), P < 0.001), and SIG greater than or equal to 2 (HR 1.63 (95% c.i. 1.33 to 1.99), P < 0.001) were independently associated with increased mortality.

Conclusion: Cervical CT-derived muscle mass and density, and markers of systemic inflammation, such as systemic inflammatory grade, may be associated with an inferior long-term prognosis after carotid endarterectomy.

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BJS Open
BJS Open SURGERY-
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3.20%
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144
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