Lub luag hauj lwm ntawm CT-scan kev ntsuam xyuas ntawm cov leeg nqaij nyob rau hauv Predicting Postoperative phais teeb meem tom qab hloov lub raum
Mar 16, 2022
Taw qhia
Kev hloov lub raumyog qhov kev kho mob siv rau qhov kawg raum tsis ua haujlwm. Piv nrog rau kev lim ntshav ntev ntev, cov neeg mob hloov pauv muaj lub neej nyob nruab nrab ntawm 9 xyoo siab dua [1]. Kev phais thiab kev kho mob tsis zoo tau raug soj ntsuam hauv cov ntaub ntawv los ntsuas qhov muaj feem cuam tshuam thiab yog li txhawm rau txhim kho kev xaiv tus neeg mob ua ntejhloov raum. Yog li, intrinsic morphometrics yam, xws li rog lossis adipose cov ntaub so ntswg faib, zoo li cuam tshuam nrog kev pheej hmoo ntawm kev mob tom qab phais [2]. Txawm li cas los xij, kev hloov pauv hauv morphometrics thiab homeostasis vim hemodialysis mus ntev yuav tsum tau soj ntsuam ntxiv txhawm rau kwv yees cov txiaj ntsig tom qab hloov pauv. Protein-zog tsis muaj zaub mov noj yog ib qho ntawm cov kev pheej hmoo paub uas ua rau muaj txiaj ntsig zoo rau kev lim ntshav tuag [3]. Kwv yees li 75 feem pua ntawm cov neeg mob hemodialysis ntawm cov npe tos raug kev txom nyem los ntawm cov protein-zog tsis muaj zaub mov noj [4, 5]. Xyoo 2019, Fab Kis Lub Tebchaws Saib Xyuas Kev Noj Qab Haus Huv tau tshuaj xyuas nws cov ntsiab lus ntawm kev noj zaub mov tsis zoo rau cov neeg laus. Peb cov txheej txheem phenotypical tau siv tam sim no: poob phaus, lub cev qhov hnyav (BMI), thiab txo cov leeg nqaij lossis ua haujlwm [6]. Qhov kev ntsuas zaum kawg, uas tau tshwm sim hauv cov lus pom zoo tshiab no, qhia txog kev xav ntawm sarcopenia hauv lub ntsiab lus ntawm kev noj zaub mov tsis zoo.
CISTANCHE yuav txhim kho lub raum / raum ua haujlwm
Txawm hais tias qhov tshwm sim ntawm sarcopenia yog kwv yees li ntawm 5 thiab 37 feem pua ntawm cov neeg mob uas mob ntev.mob raum, tsis muaj cov ntaub ntawv qhia meej ntawm cov pej xeem ntawm cov neeg mob hemodialysis [7]. Sarcopenia yog txhais los ntawm ib tug gradual thiab generalized nqaij puas. Nws yog ib qho kev pheej hmoo rau kev ntog, kev tsis taus lossis pob txha, thiab ua rau muaj kev pheej hmoo ntawm kev tuag [8, 9]. Txhawm rau ntsuam xyuas sarcopenia, tam sim no muaj cov txheej txheem kho mob uas muaj cov leeg nqaij thiab kev ua haujlwm qis (cov leeg nqaij tsis muaj zog, cov leeg nqaij qis, thiab kev ua haujlwm tsis zoo ntawm lub cev) [10]. Computed Tomography (CT) kev ntsuas ntawm cov leeg nqaij thaj tsam ntawm cov nqaij psoas-iliac yog ib qho cuab yeej zoo rau kev soj ntsuam sarcopenia vim nws cuam tshuam nrog cov leeg nqaij [11-13] thiab tau dhau los ua kev ntsuas rau kev noj haus thiab kev soj ntsuam ntawm cov neeg mob ua ntej. Kev kho mob oncology [14]
Txawm li cas los xij, kev koom tes ntawm sarcopenia thiabhloov raumpostoperative cov txiaj ntsig tau kawm tsis zoo nyob rau hauv cov ntaub ntawv tam sim no tshwj xeeb tshaj yog siv cov kev kuaj pom. Pinar et al. tau pom muaj kev koom tes ntawm sarcopenia, suav nrog psoas nto ntawm CT scan, thiab 1- xyoo tom qab hloov pauv kev phais mob nyuaj [15]. Hauv lawv txoj kev tshawb fawb, cov kws sau ntawv suav tsuas yog cov neeg rog rog lossis rog dhau. Tsis tas li ntawd, lwm txoj kev tshawb fawb tau piav qhia txog lub hnub nyoog morphometric raws li CT-scan ntsuas thiab pom tias muaj kev koom tes nrog kev ua haujlwm tom qab tag nrho cov ciaj sia [16]. Nyob rau hauv txoj kev tshawb no, peb tsom rau kev ntsuam xyuas qhov sib txheeb ntawm sarcopenia txhais los ntawm cov leeg nqaij ntsuas ntawm CT scan thiabhloov raumqhov tshwm sim hauv ib pawg ntawm cov neeg tau txais kev xaiv tsis raug xaiv.
Keywords (MeSH):hloov raum; Sarcopenia; Lub raum tsis ua haujlwm kawg; Teeb meem; kab mob raum; raum tsis ua haujlwm
CISTANCHE yuav txhim kho lub raum / raum tsis ua haujlwm
Cov ntaub ntawv thiab cov txheej txheem
Kawm tsim qauvTxhua tus neeg mob sib law liaghloov raumnyob rau hauv peb lub tsev kho mob kev kawm tau retrospectively suav nrog hauv qhov kev tshawb fawb no ntawm 2011 thiab 2018. Peb tsis suav cov neeg mob uas tau txais ntau tshaj ibhloov raum, multiorgan transplantation, patients with pre-operative CT scan performed>12 lub hlis ua ntej kev hloov pauv lossis CT scan nrog cov khoom cuav cuam tshuam cov kev ntsuas hluav taws xob (cov kua dej hauv plab, phab ntsa hematoma, tus neeg mob txav thaum lub sijhawm CT scan). Cov ntaub ntawv hais txog lub sijhawm ua haujlwm peri-operative thiab 1- xyoo rov qab tau sau los ntawm kev sau ntawv kho mob. Qhov ntev ntawm kev mus pw hauv tsev kho mob tau sau tseg, nrog rau kev ncua sijhawm rov ua haujlwm, txhais tau tias xav tau kev lim ntshav hauv 7 hnub tom qab kev phais. Cov txheej txheem rau kev tiv thaiv kab mob, induction thiab tom qab kev kho mob tau teev tseg. Qhov xav tau rau amines lossis intraoperative transfusion kuj tau qhia.
Rau txhua tus neeg mob suav nrog, cov leeg nqaij tau raug soj ntsuam ntawm axial CT-scan seem ntawm qib ntawm peb lub lumbar vertebra (L3) ua ntej kev tswj hwm ntawm qhov sib piv (tshuab teeb tsa ntawm 120 Kvp thiab siv cov kev hloov pauv tam sim no nrog a reference mAs of 400). Cov leeg nqaij pob txha (xws li cov leeg psoas, cov leeg nqaij paraspinal, sab nraud oblique, sab hauv oblique, transverse, thiab rectus abdominis) tau suav nrog siv software semi-automatic. Cov kev ntsuas tau ua los ntawm ib tus kws tshaj lij, siv Slice-O-Matic software (version 5.0; TomoVision, Montreal, Quebec, Canada). Cov leeg tau raug kuaj pom ntawm -30 thiab 150 Hounsfield units ntawm CT-scan seem. Qhov kev ntsuam xyuas no suav cov pob txha pob txha index (SMI) (cm2 / m2) los ntawm kev faib qhov chaw hla ntu (cm2) ntawm cov leeg pob txha ntawm qib peb lumbar vertebra los ntawm square ntawm tus neeg mob qhov siab (m2) ntawm CT. Cov nqaij ntshiv, nyob rau hauv Hounsfield units, kuj tau xam nyob rau tib lub L3 CT seem thiab sawv cev rau qhov nruab nrab ntom ntawm cov leeg nqaij (Fig. 1). Raws li sarcopenia tau txhais hauv kev kho mob, tsis muaj qhov kev pom zoo meej meej ntawm CT scans thiab peb tsis tuaj yeem siv cov ntsiab lus sarcopenia validated.
Txoj kev tshawb no tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees hauv cheeb tsam (Lub Kaum Hli 2019) thiab tau ua raws li cov hauv paus ntsiab lus ntawm Helsinki tshaj tawm. Cov ntaub ntawv tau tshaj tawm rau National Board for Informatics thiab Freedom (Commission Nationale Informatique thiab Liberté, CNIL).
Kev tswj xyuas tom qab ua haujlwmCov neeg mob tau saib xyuas hauv nephrology intensive care unit rau thawj 3 hnub tom qab kev phais thaum tsis muaj teeb meem ua ntej hloov mus rau nephrology department. Lub catheter tso zis thiab tso zis tau raug tshem tawm nyob rau hnub 5 thiab 6. JJ catheter tau raug tshem tawm 1 lub hlis tom qab kev phais hauv kev sib tham tshwj xeeb. Cov txheej txheem biopsy ntawm kev hloov pauv tau ua tiav ntawm 3 lub hlis.
Cov txiaj ntsigThawj qhov kawg yog qhov tshwm sim ntawm cov teeb meem loj tom qab 1 lub hlis thiab 1 xyoo tom qab hloov pauv. Cov teeb meem raug cais raws li kev faib tawm Clavien-Dindo thiab qib 3 lossis siab dua qhov teeb meem raws li qhov kev faib tawm no tau suav tias yog qhov loj.
CISTANCHE yuav txhim kho lub raum / raum mob
Kev txheeb caisCov kev txheeb xyuas kev txheeb xyuas tau ua nrog Stata software (version 15; StataCorp, College Station, Texas, USA), txiav txim siab txog ob tog thawj hom kev ua yuam kev ntawm 5 feem pua. Statistical tseem ceeb tau teem rau ap tus nqi<0.05. categorical="" variables="" were="" described="" as="" numbers="" and="" percentages,="" whereas="" quantitative="" variables="" as="" mean="" (±standard="" deviation)="" or="" median="" [interquartile="" range]="" with="" respect="" to="" their="" statistical="" distribution="" (normality="" studied="" by="" the="" shapiro–wilk="" test).="" comparisons="" between="" independent="" groups="" for="" quantitative="" parameters="" were="" performed="" by="" student's="" t-test="" or="" by="" mann–whitney="" test="" if="" t-test="" conditions="" were="" not="" met="" (normality,="" homoscedasticity="" studied="" by="" fisher–snedecor's="" test).="" inter-group="" comparisons="" of="" qualitative="" parameters="" were="" performed="" by="" the="" chi="" 2="" test="" or="" by="" fisher's="" exact="" test.="" finally,="" in="" a="" multivariate="" situation,="" logistic="" regression="" was="" implemented="" by="" considering="" the="" covariates="" with="" respect="" to="" the="" univariate="" analysis="" results="" (p≤0.1),="" to="" study="" the="" factors="" associated="" with="" major="" complications.="" the="" results="" are="" expressed="" in="" terms="" of="" odds="" ratio="" (or)="" and="" 95%="" confidence="">
Cov txiaj ntsig
Cov pejxeemZuag qhia tag nrho, 397 tus neeg mob tau mobhloov raumThaum lub sijhawm kawm uas 102 tau ua haujlwm ua ntej CT scan tsawg dua 12 lub hlis, thiab tau suav nrog hauv txoj kev tshawb no. Ntawm 102 tus neeg mob suav nrog, qhov nruab nrab hnub nyoog thiab tus qauv sib txawv (SD) yog 54 ± 28.3 xyoo, 67 (64.7 feem pua) yog txiv neej thiab 35 (35.3 feem pua) yog poj niam (Table 1). Lub sijhawm lim ntshav ua ntej hloov pauv thiab SD yog 104 ± 31.6 hnub. Zuag qhia tag nrho,
92 kev hloov pauv (88.5 feem pua) yog los ntawm cov neeg pub dawb uas tuag lawm uas 40 (38.5 feem pua) tau nthuav dav. Qhov nruab nrab thiab SD lub cev qhov hnyav thiab cov leeg pob txha index yog, feem, 25.1 ± 4.2 kg / m2 thiab 44.8 ± 12.1 cm2 / m2. Qhov nruab nrab ntawm cov leeg nqaij thiab SD yog 126 ± 46.2 cm2 thiab nws qhov ceev yog 35.4 ± 11.6 Hounsfield kev sib koom ua ke.
Ib lub hlis tom qab hloov pauv cov teeb meemNtawm 1 lub hlis tom qab hloov pauv, 67 tus neeg mob (63.9 feem pua) tau muaj teeb meem uas 14 (13.8 feem pua) tau suav tias yog loj, 3 tus neeg mob (2.9 feem pua) tau hloov pauv thiab 2 tus neeg mob (2 feem pua) tuag. Cov ntsiab lus ntawm cov teeb meem no tau piav qhia nyob rau hauv Cov Lus Qhia Ntxiv 1. Nyob rau hauv univariate logistic regression tsom xam, plasmatic albuminemia, kev siv anticoagulation thiab sov ischemia lub sij hawm muaj kev cuam tshuam nrog Clavien-Dindo ntau dua los yog sib npaug rau 3 cov teeb meem tom qab phais [raws li OR (95 feem pua. CI), 0.2 (0.1–{20}.6), 7.6 (2.4–28.6) thiab {{30}} .9 (0.8–{38}}.98)] (Table 2). Thaum kawg, tsis tshua muaj plasmatic albuminemia thiab kev siv cov tshuaj tiv thaiv coagulants yog qhov ua rau muaj kev pheej hmoo ntawm kev mob ntshav qab zib hauv kev txheeb xyuas ntau yam sib txawv [raws li OR (95 feem pua CI), 0.3 (0.1–0.9) p=0.05 thiab 6.4 (1.8–27.4) p=0.01].
Ib xyoos tom qab hloov pauv kev phais mobTom qab {{0}} xyoo rov qab, rau tus neeg mob tau tuag (5.9 feem pua) thiab tsib tus neeg mob (4.9 feem pua) rov qab mus rau kev lim ntshav (Table 3). Zuag qhia tag nrho, 62 tus neeg mob (60.8 feem pua) muaj teeb meem kho mob thiab 30 (29.4 feem pua) muaj teeb meem kev phais hauv xyoo tom qab hloov pauv. Hauv kev tshuaj ntsuam univariate, cov nqaij ntshiv thiab kev siv cov tshuaj tiv thaiv coagulation tau cuam tshuam nrog qhov tshwm sim ntawm kev phais mob [raws li OR (95 feem pua CI), 0.6 (0.4–0 .9) thiab 2.8 (0.9–10.6)] (Table 4). Hauv kev txheeb xyuas ntau yam suav nrog cov kev hloov pauv uas nws tus nqi qis dua lossis sib npaug ntawm 0.1, cov leeg nqaij qis thiab qhov seem diuresis tseem muaj feem cuam tshuam ntawm 1- xyoo phais mob [raws li OR (95 feem pua CI ), 0.6 (0.3–0.9) p=0.05 thiab 4.9 (1.2–23) p=0.05]. Qhov chaw nyob hauv qab qhov nkhaus (AUC) ntawm 1-xyoo kev kwv yees tus qauv muaj teeb meem nrog rau cov seem diuresis thiab cov nqaij ntshiv yog 0.64 (Fig. 2).
Kev sib tham
Hauv peb txoj kev tshawb fawb, peb tau soj ntsuam kev sib koom ua ke ntawm sarcopenia thiab lub sijhawm luvhloov raumCov txiaj ntsig tau siv CT-scan seem. Peb pom tau hais tias cov neeg mob uas qis dua albuminemia muaj teeb meem ntau dua ntawm 1- hli tom qab hloov pauv. Thaum muaj hnub nyoog 1 xyoos, cov leeg nqaij qis tau cuam tshuam nrog kev phais mob thaum lub albuminemia zoo li tsis muaj kev cuam tshuam. Kev siv cov tshuaj tiv thaiv coagulants kuj muaj feem cuam tshuam nrog cov teeb meem, ntawm 1 lub hlis thiab 1 xyoos tom qab hloov pauv. Qhov tshwm sim ntawm sarcopenia hauv cov neeg mob ntshav lim ntshav yog li ntawm 5 txog 37 feem pua, nyob ntawm theem ntawmraum tsis ua haujlwm[7, 17] ib. Nyob rau hauv cov ntsiab lus no, protein-zog undernutrition tuaj yeem piav qhia los ntawm ntau lub tswv yim: (1) kev noj tsawg tsawg, vim kev txwv tsis pub noj zaub mov; (2) cuam tshuam ntawm cov metabolism hauv cov protein los ntawm kev ua lub cev tsis muaj zog, nce catabolism cuam tshuam nrog metabolic acidosis, thiab txo qis anabolism cuam tshuam nrog peripheral tsis kam rau insulin; (3) protein poob vim proteinuria [18]. Kev lim ntshav ntev ntev li no ua rau muaj kev cuam tshuam ntawm metabolic thiab noj zaub mov tsis zoo los ntawm cov neeg mob thaum kawg.mob raum[19]. Txawm hais tias nws tau pom tias sarcopenia tau cuam tshuam nrog cov txiaj ntsig tom qab phais hauv thaj chaw ntawm oncology, nws cuam tshuam hauvhloov raumtsis meej pem.
Qee qhov kev tshawb fawb rov qab hauv lub ntsws thiab lub siab hloov pauv tau hais txog qhov pom zoo ntawm kev hloov pauv ua ntej sarcopenia [20, 21]. Yog li ntawd, peb txoj kev tshawb fawb yog ib qho ntawm ob peb los ntsuas qhov cuam tshuam ntawm CT-scan ntsuas sarcopenia thiab cov leeg nqaij ntom ntawm cov txiaj ntsig tom qab hloov pauv. Peb txoj kev tau muab lub hom phiaj poob nyiaj thiab hloov pauv cov leeg nqaij, txawm tias nyob rau hauv cov tib neeg uas muaj BMI li qub lossis supra-normal BMI [22]. Vim tias cov neeg mob ntshav lim ntshav muaj ntau qhov hnyav, peb xav tias txoj kev no yog qhov tshwj xeeb ntawm cov neeg no. Ntxiv mus, nws twb tau validated raws li ib tug npaum cov cuab yeej los ntsuam xyuas sarcopenia [9, 23]. Peb tsis tuaj yeem ua pov thawj tias muaj kev koom tes tseem ceeb ntawm sarcopenia thiab cov teeb meem ntawm 1 lub hlis thiab 1 xyoo tom qab thawj lub raum hloov. Txawm li cas los xij, lub ntsiab lus ntawm sarcopenia tseem tsis pom zoo tam sim no. Raws li kev ntsuas ntawm cov leeg nqaij ntawm thaj chaw CT-scan, tam sim no tsis muaj qhov kev pom zoo rau kev txhais cov sarcopenia. Tsis tas li ntawd, nws cov ntsiab lus tau hloov kho los ntawm Pawg Neeg Ua Haujlwm European ntawm Sarcopenia hauv Cov Neeg Laus (EWGSOP2) hauv 2018 thiab nws yog qhov chaw kho mob. Tseeb tiag, kev sib koom ua ke ntawm ob ntawm peb yam hauv qab no tam sim no tso cai rau kev kuaj mob sarcopenia: qhov txo qis hauv cov leeg nqaij, thiab / lossis txo qis hauv cov leeg nqaij, thiab / lossis txo qis hauv kev ua haujlwm ntawm kev kuaj lub cev [10]. Qhov kev txhais no yog tam sim no raws li kev ua haujlwm ntau dua li cov qauv anatomical. Ib qho kev cuam tshuam hauv cov leeg nqaij zoo li no yeej dhau ntawm cov leeg nqaij nws tus kheej. Los ntawm qhov kev xav no, cov nqaij ntshiv tuaj yeem yog cov cuab yeej nthuav thiab ntxov los soj ntsuam cov khoom noj khoom haus ntawm cov neeg mob hauv daim ntawv tos. Txawm li cas los xij, peb tuaj yeem ua pov thawj kev sib raug zoo ntawm cov leeg nqaij thiab cov txiaj ntsig tom qab hloov pauv. Tseeb tiag, cov nqaij ntshiv txo qis, qhia txog qib ntawm fatty infiltration ntawm cov leeg nqaij, tuaj yeem yog thawj kauj ruam ntawm cov leeg nqaij degeneration lub luag haujlwm rau kev hloov pauv. Cov nqaij ntshiv kuj yog piv rau cov neeg mob tsis hais lawv cov poj niam los yog cev nqaij daim tawv qhov Performance index kom ntseeg tau tias muaj ntau yam [24].
Peb txoj kev tshawb fawb nthuav qhia ntau yam kev txwv. Ua ntej, peb txoj kev kawm tsim (monocentric thiab retrospective) thiab cov ntsiab lus tsawg tuaj yeem cuam tshuam peb cov txiaj ntsig. Qhov thib ob, ib nrab ntawm cov neeg mob uas raug mobhloov raumThaum lub sijhawm kawm raug tshem tawm vim lawv tsis muaj CT scan hauv 12 lub hlis dhau los ua ntej kev phais. Lub sijhawm no, qhov txwv tau raug xaiv kom muaj cov neeg mob morphometric zoo ib yam li hnub hloov pauv. Tsis tas li ntawd, raws li sarcopenia zoo li tsis zoo li qub thiab yuav hloov pauv raws sijhawm, siv 18-hli lub sijhawm raug cuam tshuam kuj tuaj yeem cuam tshuam peb cov txiaj ntsig. Qhov zoo tshaj plaws ncua sij hawm yuav tsum tau mus rau CT scan hnub ua ntejhloov raumntawm ib qho kev kawm yav tom ntej uas tsim nyog; Txawm li cas los xij, peb ntseeg tias qhov kev tshawb fawb no yuav tsum raug pom los ua pov thawj ntawm lub tswv yim rau kev kawm ntxiv. Thaum kawg, CT-scan kev ntsuam xyuas ntawm sarcopenia tseem tsis tau muaj tus qauv thiab cov neeg mob tuaj yeem raug cais tsis raug. Hauv qhov ntsuas no, kev ntsuas ntawm cov leeg nqaij zoo li lub hom phiaj ntau dua thiab tuaj yeem ua tau
Fig. 2 ROC tsom xam ntawm cov qauv sib txawv ntau yam kwv yees 1- xyoo phais teeb meem. AUC ntawm tus qauv 1-xyoo kev kwv yees qhov teeb meem nrog rau cov seem diuresis thiab cov leeg nqaij ntom ntom yog 0.64 ib qho kev coj ua kom zoo dua tom qab hloov pauv cov txiaj ntsig kwv yees. Cov kev tshawb fawb ntxiv ntawm cov ntsiab lus tseem xav tau los tsim kom pom tseeb dua qhov cuam tshuam ntawm sarcopenia ntawm qhov tshwm sim ntawm cov teeb meem tom qab hloov lub raum.
Xaus
Qhov tshwm sim ntawm qhov teeb meem ntawm 1 lub hlis thiab 1 xyoo tom qab thawj zaughloov lub raumtsis zoo li cuam tshuam nrog cov xwm txheej sarcopenic ntawm cov neeg mob. Txawm li cas los xij, CT-scan cov nqaij ntshiv thiab plasmatic albuminemia tau cuam tshuam nrog pejorative tom qab hloov pauv cov txiaj ntsig thiab tuaj yeem ua ntej ua cov cuab yeej twv ua ntej rau cov neeg mob no.
