颞肌厚度作为急性缺血性卒中预后标志物：一项系统评价

文献信息

中文摘要

背景： 在常规神经影像上测量的颞肌厚度（TMT）已成为肌肉减少症的影像学标志物，但其在急性缺血性卒中中的预后价值尚未明确。本系统评价探讨了TMT是否与急性缺血性卒中后的功能状态、吞咽结局和死亡率相关。方法：一项遵循PRISMA的系统评价检索了2000年至2025年间报告TMT及至少一项临床结局的成人急性缺血性卒中观察性研究。检索了PubMed、MEDLINE、Embase、Web of Science和Scopus。两名评价者独立筛选记录并提取数据。使用ROBINS-I和纽卡斯尔-渥太华量表评估偏倚风险，并针对预后因素工具进行论证。由于TMT定义和结局指标存在异质性，采用叙述性方法综合研究结果。结果：四项队列研究共1361例患者符合纳入标准。平均年龄为69.7岁，53.9%为男性。研究水平的平均TMT范围为5.2至6.35 mm；在报告TMT定义的肌肉减少症状态的队列中，704例患者的患病率为51.8%（365/704）。在各研究中，较低的TMT或TMT定义的肌肉减少症与较差的功能结局和较高的死亡率相关，且独立于年龄和卒中严重程度。在一个取栓队列中，TMT每增加1 mm，功能独立的几率增加（校正OR 1.14，95% CI 1.03-1.27）。相反，每增加1 mm，90天死亡率降低（校正OR 0.71，95% CI 0.54-0.93）。较低的TMT还预测了延长的鼻胃管依赖。结论：TMT是一种简单的基于CT或MRI的测量指标，与急性缺血性卒中后的残疾、吞咽困难和生存率 consistently 相关。当前证据为观察性研究，支持进一步的前瞻性验证和测量标准化，而非立即用于常规决策。

英文摘要

Background: Temporalis muscle thickness (TMT) measured on routine neuroimaging has emerged as a radiological marker of sarcopenia, but its prognostic value in acute ischemic stroke is not well defined. This systematic review examined whether TMT is associated with functional status, swallowing outcomes, and mortality after acute ischemic stroke. Methods: A PRISMA-guided systematic review identified observational studies (2000-2025) reporting TMT and at least one clinical outcome in adults with acute ischemic stroke. PubMed, MEDLINE, Embase, Web of Science, and Scopus were searched. Two reviewers independently screened records and extracted data. Risk of bias was assessed using ROBINS-I and the Newcastle-Ottawa Scale, with justification relative to prognostic-factor tools. Due to heterogeneity in TMT definitions and outcome measures, findings were synthesized narratively. Results: Four cohorts, including 1361 patients, met the inclusion criteria. Mean age was 69.7 years, and 53.9% were male. Study-level mean TMT ranged from 5.2 to 6.35 mm; among the 704 patients in cohorts that reported TMT-defined sarcopenia status, prevalence was 51.8% (365/704). Across studies, lower TMT or TMT-defined sarcopenia was associated with poorer functional outcomes and higher mortality, independent of age and stroke severity. In one thrombectomy cohort, each 1-mm increase in TMT increased the odds of functional independence (adjusted OR 1.14, 95% CI 1.03-1.27). In contrast, each 1-mm increase reduced 90-day mortality (adjusted OR 0.71, 95% CI 0.54-0.93). Lower TMT also predicted prolonged nasogastric tube dependence. Conclusions: TMT is a simple CT- or MRI-based measure that is consistently associated with disability, dysphagia, and survival after acute ischemic stroke. Current evidence is observational and supports further prospective validation and measurement standardization rather than immediate routine decision-making use.