Higher subcutaneous adipose tissue radiodensity is associated with increased mortality in patients with cirrhosis.
Higher subcutaneous adipose tissue radiodensity is associated with increased mortality in patients with cirrhosis.
复制标题
DOI：
10.1016/j.jhepr.2022.100495
复制
发表时间：
2022-07
期刊：
影响因子：
8.3
通讯作者：
Montano-Loza, Aldo J.
中科院分区：
文献类型：
--
作者：
Ebadi, Maryam;Dunichand-Hoedl, Abha R.;Rider, Elora;Kneteman, Norman M.;Shapiro, James;Bigam, David;Dajani, Khaled;Mazurak, Vera C.;Baracos, Vickie E.;Montano-Loza, Aldo J.
肌肉减少症与肝硬化死亡率之间的关联已得到广泛认可。然而，人们对脂肪组织放射密度（指示生物学特征）的临床意义知之甚少。本研究旨在确定高皮下脂肪组织 (SAT) 放射密度与生存之间的关联，比较健康人群和肝硬化患者之间高 SAT 放射密度的患病率，并确定计算机断层扫描 (CT) 测量的 SAT 放射密度与组织学特征之间的关联。成年肝硬化患者 (n = 786) 和健康捐献者 (n = 129) 的 CT 图像被纳入肝移植 (LT) 评估的一部分。 12 名肝硬化患者在 LT 时从切口部位采集腹部 SAT 活检组织（1-2 g）。大多数患者为男性 (67%)，终末期肝病 (MELD) 平均模型评分为 15 ± 8。女性的 SAT 放射密度高于 -83 HU（次分布风险比 [sHR] 1.84，95% CI 1.20–2.85，p = 0.006），男性的 SAT 放射密度高于 -74 HU（sHR 1.51，95% CI） 1.05–1.18，p = 0.02）在调整竞争风险分析中的混杂因素后与最高死亡风险相关。肝硬化患者的高 SAT 放射密度频率为 26%，而健康供体的这一比例为 2%（p <0.001）。 SAT 放射密度与 SAT 脂肪细胞的平均横截面积之间存在负相关（r = -0.67，p = 0.02）。在高 SAT 放射密度的患者中，主要是收缩、较小且间隙扩大的脂肪细胞，而在低 SAT 放射密度的患者中观察到较大的脂肪细胞，且细胞质边缘较薄（744 ± 400 vs. 1,521 ± 1,035 μm2，p <0.001）。高 SAT 放射密度经常出现，并且与肝硬化较高的死亡率相关。高 SAT 放射密度患者的 SAT 形态重排可能表明脂质储存减少和组织特征改变。皮下脂肪组织（皮下脂肪）质量差与终末期肝病患者死亡率较高相关。脂肪组织质量较差的患者的脂肪细胞较小。皮下脂肪组织 (SAT) 放射密度可以通过 CT 以亨斯菲尔德单位 (HU) 客观测量。 SAT 放射密度构成脂肪组织质量的间接替代标志。肝硬化的高 SAT 放射密度定义为女性 >-83 HU 和男性 >-74 HU。超过四分之一的肝硬化患者存在高 SAT 放射密度，并且与较高的死亡率相关。高 SAT 放射密度可能表明脂肪组织重塑并伴有萎缩的形态特征。
Association between sarcopenia and mortality in cirrhosis is well recognised; however, little is known about the clinical implications of adipose tissue radiodensity, indicative of biological features. This study aimed to determine an association between high subcutaneous adipose tissue (SAT) radiodensity and survival, compare the prevalence of high SAT radiodensity between healthy population and patients with cirrhosis, and identify an association between computed tomography (CT)-measured SAT radiodensity and histological characteristics. Adult patients with cirrhosis (n = 786) and healthy donors (n = 129) with CT images taken as part of the liver transplant (LT) assessment were included. Abdominal SAT biopsies (1–2 g) were harvested from the incision site at the time of LT from 12 patients with cirrhosis. The majority of patients were male (67%) with a mean model for end-stage liver disease (MELD) score of 15 ± 8. SAT radiodensity above -83 HU in females (sub-distribution hazard ratio [sHR] 1.84, 95% CI 1.20–2.85, p = 0.006) and higher than -74 HU in males (sHR 1.51, 95% CI 1.05–1.18, p = 0.02) was associated with the highest mortality risk after adjusting for confounders in competing risk analysis. The frequency of high SAT radiodensity was 26% for those with cirrhosis, compared with 2% in healthy donors (p <0.001). An inverse correlation was found between SAT radiodensity and the mean cross-sectional area of SAT adipocytes (r = -0.67, p = 0.02). Shrunken, smaller adipocytes with expanded interstitial space were predominant in patients with high SAT radiodensity, whereas larger adipocytes with a thin rim of cytoplasm were observed in patients with low SAT radiodensity (744 ± 400 vs. 1,521 ± 1,035 μm2, p <0.001). High SAT radiodensity frequently presents and is associated with a higher mortality in cirrhosis. SAT morphological rearrangement in patients with high SAT radiodensity might indicate diminished lipid stores and alterations in tissue characteristics. Poor quality of subcutaneous adipose tissue (fat under the skin) is associated with higher mortality in patients with end-stage liver disease. Fat cells are smaller in patients with poor adipose tissue quality. Subcutaneous adipose tissue (SAT) radiodensity can be objectively measured by CT in Hounsfield units (HU). SAT radiodensity constitutes an indirect surrogate marker of adipose tissue quality. High SAT radiodensity in cirrhosis was defined as >-83 HU in females and >-74 HU in males. High SAT radiodensity presents in more than a quarter of patients with cirrhosis and is associated with higher mortality. High SAT radiodensity might indicate adipose tissue remodelling with morphological features of atrophy.
登录
查看更多内容
DOI：
10.1002/lt.24750
发表时间：
2017-05
期刊：
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
影响因子：
--
作者：
Carey EJ;Lai JC;Wang CW;Dasarathy S;Lobach I;Montano-Loza AJ;Dunn MA;Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium
通讯作者：
Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium
影响因子：
4.4
作者：
da Cunha, Ademar Dantas, Jr.;Silveira, Marina Nogueira;Carvalheira, Jose Barreto Campello
通讯作者：
Carvalheira, Jose Barreto Campello
影响因子：
7.9
作者：
Karastergiou K;Smith SR;Greenberg AS;Fried SK
通讯作者：
Fried SK
影响因子：
3.3
作者：
Shen, W;Punyanitya, M;Heshka, S
通讯作者：
Heshka, S
影响因子：
8.3
作者：
Tapper, Elliot B.;Zhang, Peng;Su, Grace L.
通讯作者：
Su, Grace L.