急性缺血性卒中中的咬肌质量：与功能结局、吞咽困难和脑小血管病负担的关联
Masseter muscle quality in acute ischemic stroke: Associations with functional outcome, dysphagia, and cerebral small vessel disease burden.
文献信息
| PMID | 42880024 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yoshitaka Tsuboi |
| 作者单位 | Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan. |
| 期刊 | Clinical neurology and neurosurgery |
| SCI 分区 | Q2 |
| IF | 1.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 咬肌——作为全身肌肉量和质量的替代指标——在肿瘤学中已与吞咽困难和死亡率相关，但在急性缺血性卒中（AIS）中的证据有限。脑小血管病（SVD）可能通过氧化应激和炎症发挥作用。我们研究了咬肌状态在AIS中的预后价值、其与吞咽困难的关系以及与SVD的关联。
方法： 连续筛选2022年1月至2024年3月期间发病一周内入院的AIS患者。不良结局定义为3个月时mRS 3-6。在增强CT上，测量颧弓下方2 cm处的咬肌横截面，以计算咬肌指数（MMI = 面积/身高2；cm2/m2，数量）和咬肌密度（MMD = 平均衰减值；HU，质量）。较低的HU表示肌内脂肪较多。吞咽困难定义为第7天功能性经口摄入量表≤5。SVD负担通过总SVD评分评估。
结果： 在100例患者中（72例[72%]男性；中位年龄69岁），24例出现不良结局。在多变量分析中，较低的MMD与不良结局显著相关（p < 0.05）。ROC分析确定MMD截断值为55.5 HU（AUC，0.663；敏感性，0.908；特异性，0.375）。在多变量线性回归中，较高的SVD负担与较低的MMD相关（p < 0.05）。在多变量分析中，较低的MMI和MMD均与急性吞咽困难相关（p < 0.05）。
结论： 咬肌质量可能作为AIS的预后标志物，并可能受SVD影响。其数量和均与急性吞咽困难相关。
英文摘要
BACKGROUND: The masseter muscle-a surrogate of systemic muscle mass and quality-has been linked to dysphagia and mortality in oncology, but evidence in acute ischemic stroke (AIS) is limited. Cerebral small vessel disease (SVD), via oxidative stress and inflammation, may contribute. We investigated the prognostic value of masseter status in AIS, its relation to dysphagia, and association with SVD.
METHODS: Consecutive AIS patients admitted between January 2022 and March 2024 within one week of onset were screened. Unfavorable outcome was defined as mRS 3-6 at 3 months. On contrast-enhanced CT, masseter cross-section 2 cm below the zygomatic arch was measured to calculate masseter muscle index (MMI = area/height2; cm2/m2, quantity) and masseter muscle density (MMD = mean attenuation; HU, quality). Lower HU indicated greater intramuscular fat. Dysphagia was defined as Functional Oral Intake Scale ≤ 5 at day 7. SVD burden was assessed by total SVD score.
RESULTS: Among 100 patients (72 [72%] male; median age, 69 years), 24 had unfavorable outcomes. Lower MMD was significantly associated with unfavorable outcomes in multivariable analysis (p < 0.05). ROC analysis identified an MMD cutoff of 55.5 HU (AUC, 0.663; sensitivity, 0.908; specificity, 0.375). Higher SVD burden was associated with lower MMD in multivariable linear regression (p < 0.05). Both lower MMI and MMD were associated with acute dysphagia in multivariable analysis (p < 0.05).
CONCLUSIONS: Masseter muscle quality may serve as a prognostic marker in AIS, potentially influenced by SVD. Both quantity and quality were linked to acute dysphagia.