多模态超声对肌少症患者肌肉质量及硬度的临床应用研究

The clinical application study of multimodal ultrasound on the quantitative measurement of muscle mass and hardness in sarcopenia patients

目的应用肌骨超声检查肌少症患者腓肠肌内侧头肌肉的质量及硬度,探索肌骨超声对其临床应用价值。方法依照亚洲肌少症工作组(AWGS)诊断标准,选取肌少症患者60例为病例组,年龄匹配的健康老年人24例为对照组。利用二维灰阶超声测量右侧腓肠肌内侧头肌肉厚度、羽状角及肌束长度;剪切波弹性成像技术测量肌肉在放松状态及收缩状态的杨氏模量,比较分析两组间各超声参数差异,分析病例组右侧腓肠肌内侧头的肌肉厚度、羽状角、肌束长度与肌少症的相关性,通过ROC曲线分析超声测值预判肌少症的价值。结果肌少症组患者右侧腓肠肌内侧头的肌肉厚度(10.0±2.1)mm、羽状角(16.9±3.2)°、肌束长度(30.5±3.2)mm、放松状态及收缩状态杨氏模量值[(11.5±2.2)kPa、(23.2±4.0)kPa]均低于对照组[(14.8±1.2)mm、(21.7±2.5)°、(34.2±1.6)mm、(15.0±1.5)kPa、(30.6±2.8)kPa,t=10.454、3.612、5.631、6.922、8.173,均P<0.05],且放松状态杨氏模量值较收缩状态低;肌少症患者肌肉厚度及杨氏模量与年龄呈负相关(r=-0.307、-0.285,P<0.05);与四肢骨骼肌质量指数呈正相关(r=0.838、0.761,P<0.01);肌肉厚度及杨氏模量是肌少症显著相关的因素(OR=4.576、3.867)。超声检查右侧腓肠肌内侧头诊断肌少症ROC曲线下阈值为:肌肉厚度11 mm、羽状角17°、肌束长度32 mm、放松状态下杨氏模量12.4 kPa,其中肌肉厚度对诊断肌少症的敏感性及特异性最佳,分别为86.7%、100%。结论超声对腓肠肌内侧头肌肉质量及肌肉硬度的测量,可以量化反映肌肉质量减低及肌肉硬度下降,为肌少症的预判提供影像学指标。

Objective To evaluate the clinical value of musculoskeletal ultrasound in the diagnosis of sarcopenia by measuring the muscle mass and hardness of medial head of gastrocnemius.Methods According to the diagnostic criteria of Asian Working Group for Sarcopenia(AWGS),60 patients with sarcopenia were selected as the case group and 24 normal elderly people with matched age as the control group.Two dimensional gray-scale ultrasound was used to measure the muscle thickness,pinnate angle and fascicle length of the right gastrocnemius muscle,and the shear wave elastography was used to measure the Young's modulus(the dynamic stiffness)of the muscle in the states of relaxation and contraction,respectively.The differences of various ultrasound parameters between the two groups were compared,and the relativity of muscle thickness of the medial head of the right gastrocnemius muscle,the feather horn,fascicle length in the case group with sarcopenia was analyzed.The value of the ultrasound measurements in predicting sarcopenia was analyzed by ROC curve.Results The muscle thickness(10.0±2.1)mm,pinnate angle(16.9±3.2)°,fascicle length(30.5±3.2)mm and Young's modulus[(11.5±2.2)kPa in relaxation state,(23.2±4.0)kPa in contraction state]of the right gastrocnemius muscle were lower in the sarcopenia group than in the control group with matched age[(14.8±1.2)mm,(21.7±2.5)°,(34.2±1.6)mm,(15.0±1.5)kPa,(30.6±2.8)kPa,respectively,t=10.454,3.612,5.631,6.922,8.173,all P<0.05].The Young's modulus value was lower in relaxed state than in the contraction state.Pearson correlation analyses showed the muscle thickness and Young modulus were negatively correlated with the age(r=-0.307,-0.285,P<0.05),and the muscle thickness was positively correlated with the limb skeletal muscle mass index(r=0.838,0.761,P<0.01).Logistic regression analysis showed the muscle thickness and Young's modulus were significantly correlated with sarcopenia(OR=4.576,3.867).ROC analysis revealed that the threshold values of ultrasound examination of the right gastrocnemius muscle medial head for diagnosis of sarcopenia were as follows:muscle thickness of 11 mm,pinnate angle of 17 degrees,fascicle length of 32 mm,Young modulus at the relaxation state of 12.4 kPa.The sensitivity and specificity of muscle thickness for diagnosis of sarcopenia were the best(86.7%and 100%,respectively)as compared with other measurements.Conclusions The measurement of muscle mass and muscle hardness of the medial head of gastrocnemius by ultrasound can reflect the decrease of muscle mass and muscle hardness quantitatively,and provide imaging indicators for the prediction of sarcopenia.