新疆医科大学学报

目的探讨脑萎缩和咀嚼肌肌少症与老年创伤患者1年死亡率的相关性。方法回顾性分析2017年3月-2020年6月在首都医科大学附属北京地坛医院住院的327例老年创伤患者的病历资料。从患者入院CT图像中,测量咀嚼肌横截面积(MCSA)脑萎缩指数(BAI)。依据测量结果将患者分为4组:仅患有咀嚼肌肌少症的患者(肌少症组,n=72),仅患有脑萎缩的患者(脑萎缩组,n=71),同时患有咀嚼肌肌少症和脑萎缩的患者(肌少症+脑萎缩组,n=92),两种情况均不存在患者(对照组,n=92)。比较4组患者出院后1年死亡率。结果 4组患者1年死亡率差异有统计学意义(P=0.013),多重比较显示,只有肌少症+脑萎缩组患者与对照组间差异有统计学意义(P=0.025)。多因素Cox比例风险模型回归分析显示,在调整年龄、共病、临床病程和损伤特征等协变量后,MCSA和BAI的Z评分均与1年死亡率相关。MCSA的标准差每<1个平均值,患者的死亡风险增加1倍[HR(95%CI):2.0(1.2～3.1)];BAI的标准差每>1个平均值,患者的死亡风险增加1倍:[HR(95%CI):2.0(1.1～3.5)]。结论基于入院头颅CT筛查的MCSA和BAI与老年创伤患者1年死亡率增加相关。同时患有脑萎缩和咀嚼肌肌少症进一步增加了患者的死亡风险。这些指标可能成为患者出院后结局的预测因素,用于指导制定针对性的干预方案。

Objective To investigate the relationship between brain atrophy, masticatory myomatosis and 1-year mortality in elderly trauma patients. Methods The medical records of 327 elderly traumatic patients hospitalized in Beijing Ditan Hospital Affiliated to Capital Medical University from March 2017 to June 2020 were retrospectively analyzed, and the demographic and disease information of the patients were collected. From the patients' admission CT images, the masticatory muscle cross-sectional area(MCSA) and brain atrophy index(BAI) were measured. The patients were divided into four groups according to the measurement results: the sarcopenia group, which was patients with masticatory sarcopenia only, n=72; the brain atrophy group, which was patients with brain atrophy only, n=71; the sarcopenia + brain atrophy group, which was patients with both masticatory sarcopenia and brain atrophy, n=92; and the control group, which was absent in both conditions, n=92. The primary outcome measure was allcause mortality 1 year after discharge. Results There was a significant difference in 1-year mortality among the four groups(P=0.013), and multiple comparisons showed that only patients in the sarcopenia + brain atrophy group were significantly different from the control group(P=0.025). Multivariate Cox proportional hazards model regression analysis showed that Z-scores of both MCSA and BAI were independently associated with 1-year mortality after adjusting for covariates such as age, comorbidity, clinical course, and injury characteristics. For each < 1 mean of the standard deviation of the MCSA, the patient's risk of death doubled [HR(95% CI): 2.0(1.2-3.1)]; for each >1 mean of the standard deviation of the BAI, the patient's risk of death doubled: [HR(95% CI): 2.0(1.1-3.5)]. Conclusion MCSA and BAI based on admission cranial CT screening are independently associated with increased 1-year mortality in elderly trauma patients. Concomitant brain atrophy and masticatory myopathy further increase the risk of death in patients. These measures may become predictors of patients' outcomes after discharge and are used to guide the development of targeted intervention programs.