双能X线和胸部CT测定健康体检者骨骼肌质量的比较研究

doi:10.3969/j.issn.1003-9198.2023.07.010

摘要/Abstract

摘要： 目的分析双能X线(DXA)法测定的肌量减少与胸部CT法测定的肌量减少是否具有相关性,探索胸部CT在老年肌少症诊断中的潜在价值。方法回顾性分析80例60岁以上同时行胸部CT检查和DXA体成分分析的健康体检者,根据四肢骨骼肌质量指数(ASMI)将其分成肌量减少组和正常组,比较2组一般资料的差异。根据第12胸椎(T12)肌肉CT值定义CT肌量减少,分析两种检测方法的诊断一致性,并分析两者相关因素的差异。结果 DXA诊断的肌量减少19例(23.75%),肌量减少组T12肌肉CT值显著低于正常组(P<0.05),2 组T12、L1及主动脉弓截面的肌面积及肌肉指数差异无统计学意义(P>0.05)。CT诊断的肌量减少30例,CT法阳性率高于DXA法(37.5%比23.75%),两者判定的一致性不足(Kappa=0.281,P=0.008)。相关分析发现,ASMI与体质量、BMI,DXA测定的总肌量、四肢肌量,T12及L1层面肌肉CT值呈正相关(P<0.01),与身高呈负相关(P<0.01)。T12肌肉CT值与年龄、性别呈负相关(P<0.01),与不同层面肌肉面积、肌肉指数及CT值均呈正相关(P<0.05或P<0.01)。结论基于CT与DXA判断的肌量减少一致性不高,可能与CT值及ASMI的相关影响因素不同有关;胸部肌肉CT值在不同层面一致性较好,体现了良好的增龄效应。胸部肌肉CT值可有效评价是否存在肌少症风险。

关键词: 双能X线, 肌少症, 四肢骨骼肌质量指数, 肌肉CT值, 老年人

Abstract: Objective To analyze the correlation between muscle mass lost detected by dual-energy X-ray absorptiometry(DXA) and chest computed tomography(CT), and to explore the potential value of chest CT in the diagnosis of sarcopenia. Methods A retrospective analysis was performed in 80 elderly receiving physical examination who underwent both chest CT examination and DXA body composition analysis. According to the definition of Asian Working Group for sarcopenia(AWGS), all subjects were divided into muscle mass loss group and normal group based on appendicular skeletal mass index(ASMI). The clinical data, muscle radiodensity and skeletal muscle area detected by chest CT were compared between the two groups. According to CT muscle radiodensity of T12, muscle mass loss was defined(male with CT value <37.5 Hu; female with CT value <31.5 Hu). The consistency of the two methods in diagnosing muscle mass loss was analyzed, and the related factors of muscle mass loss detected by the two methods were analyzed respectively. Results There were 19 cases(23.75%) of people with muscle mass loss judged by DXA. The CT skeletal muscle radiodensity of T12 in the muscle mass loss group was significantly lower than that in the normal group(P<0.05).There were no significant differences in the muscle area and muscle index of T12, L1 and aortic arch cross-sections between the two groups(P>0.05). There were 30 cases(37.5%) with muscle mass loss according to CT muscle radiodensity. The consistency of the two methods was statistically significant but with low efficiency(Kappa=0.281, P=0.008). Correlation analysis showed that ASMI was positively correlated with body mass, BMI, total muscle mass and limb muscle mass detected by DXA(P<0.001), negatively correlated with height(P<0.001). In addition, ASMI was positively correlated with CT muscle radiodensity at T12 and L1 levels(P<0.05). CT muscle radiodensity of T12 were significantly negatively correlated with age and gender(P<0.05), positively correlated with muscle area, area index and CT muscle radiodensity at L1 and aortic arch cross-sections(P<0.05 or P<0.01). Conclusions The diagnostic consistency of muscle mass loss based on CT and DXA is low, which may be due to different relevant factors of CT muscle radiodensity and ASMI. CT muscle radiodensity has comparable consistency at different level of chest muscle with aging effect. Therefore, chest CT scan can be used to evaluate the risk of sarcopenia.

Key words: dual-energy X-ray;sarcopenia;appendicular skeletal mass index;muscle radiodensity, aged

中图分类号:

R 445
R 592

廖晨芳, 徐宗政, 祁慧娟, 李庆祝, 王德国. 双能X线和胸部CT测定健康体检者骨骼肌质量的比较研究[J]. 实用老年医学, 2023, 37(7): 685-689.

LIAO Chen-fang, XU Zong-zheng, QI Hui-juan, LI Qing-zhu, WANG De-guo. A comparative study of skeletal muscle mass detected by DXA and chest CT in subjects undergoing physical examination[J]. Practical Geriatrics, 2023, 37(7): 685-689.

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