肝移植术前肌少症影响术后不良结局:单中心回顾性队列研究*

doi:10.3969/j.issn.1672-5069.2026.05.026

摘要/Abstract

摘要： 目的探讨术前肌少症对接受肝移植(LT)患者术后不良结局的影响。方法采用单中心回顾性队列研究,纳入2015年1月～2022年9月首都医科大学附属北京佑安医院接受同种异体LT治疗的321例成年患者。术前行腹部CT扫描测量和计算第3腰椎骨骼肌面积(L3-SMA),并经身高平方校正,得到L3-SMI和骨骼肌辐射衰减(SM-RA)。应用二元Logistic回归模型分析影响术后死亡的危险因素。结果在321例接受LT治疗的成年患者中,术前发现肌少症者85例(26.5%),无肌少症者236例(73.5%);男性肌少症患病率显著高于女性(29.2%对14.0%,P＜0.01);肌少症组年龄更大,体质量更轻,BMI更低,合并肝硬化比例更高,合并重度贫血比例更高(P＜0.01);肌少症组L3-SMA、L3-SMI和SM-RA分别为(101.5±17.0)cm²、(34.0±4.8)cm²/m²和(35.2±7.5)Hu,均显著低于非肌少症组【分别为(136.2±25.0)cm²、(46.6±7.1)cm²/m²和(38.9±6.7)Hu,P＜0.01];肌少症组术后28 天生存率显著低于非肌少症组(80.0%对91.1%,P=0.006),1年生存率也显著低于非肌少症组(75.3%对87.3%,P=0.008);多因素分析显示,肌少症、年龄、肝性脑病和MELD-Na评分均为影响术后28 d死亡的独立危险因素,而年龄和MELD-Na评分为影响术后1年死亡的独立危险因素。结论术前肌少症是影响LT术后短期不良预后的危险因素,行CT扫描测量L3-SMI和SM-RA可帮助评估肌少症的存在。

关键词: 肝移植, 肌少症, 第三腰椎骨骼肌指数, 骨骼肌辐射衰减, 生存, 危险因素

Abstract: Objective The aim of this study was to investigate impact of preoperative sarcopenia on postoperative outcomes in patients with end-stage liver disease undergoing liver transplantation (LT). Methods A single-center retrospective cohort study was conducted, enrolling 321 adult patients who underwent allogeneic LT at Beijing You’an Hospital, Capital Medical University, between January 2015 and September 2022. The third lumbar skeletal muscle area (L3-SMA), third lumbar skeletal muscle index (L3-SMI) and skeletal muscle radiation attenuation (SM-RA) were measured by using abdominal CT scans and sarcopenia was diagnosed based on CT results. Binary Logistic regression analysis was applied to reveal risk factors. Results Of the 321 patients receiving LT, preoperative sarcopenia was found in 85 cases (26.5%); sarcopenia was more common in male than in female (29.2% vs. 14.0%,P＜0.01); elderly age, decreased BMI, concomitant liver cirrhosis and severe anemia were frequent in patients with sarcopenia (P＜0.01); L3-SMA, L3-SMI and SM-RA in patients with sarcopenia were (101.5±17.0)cm², (34.0±4.8)cm²/m² and (35.2±7.5)Hu, all much lower than [(136.2±25.0)cm², (46.6±7.1)cm²/m² and (38.9±6.7)Hu, respectively, P＜0.01] in those without sarcopenia; survival at 28 days in patients with sarcopenia was much lower than in those without (80.0% vs. 91.1%, P=0.006), and survival at one year was also significantly lower than in without(75.3% vs. 87.3%, P=0.008); binary Logistic regression analysis showed that sarcopenia, age, hepatic encephalopathy and end-stage liver disease-sodium (MELD-Na) score were all the independent risk factors for poor prognosis at day 28, and age and MELD-Na score were the independent risk factors for poor prognosis at one-year. Conclusion Preoperative sarcopenia could lead to poor short-term postoperative outcomes in patients undergoing LT, and CT-based assessment of L3-SMI and SM-RA could provide evidence for diagnosis of sarcopenia.

Key words: Liver transplantation, Sarcopenia, Third lumbar skeletal muscle index, Skeletal muscle radiation attenuation, Survival, Risk factors

段小宛, 余朋飞, 孔明, 刘菊芬. 肝移植术前肌少症影响术后不良结局:单中心回顾性队列研究^*[J]. 实用肝脏病杂志, 2026, 29(5): 741-744.

Duan Xiaowan, Yu pengfei, Kong Ming, et al. Preoperative sarcopenia impacting postoperative short-term outcomes in recipients undergoing liver transplantation: A single-center retrospective cohort study[J]. Journal of Practical Hepatology, 2026, 29(5): 741-744.

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肝移植术前肌少症影响术后不良结局:单中心回顾性队列研究^*

Preoperative sarcopenia impacting postoperative short-term outcomes in recipients undergoing liver transplantation: A single-center retrospective cohort study

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