老年ICU-AW患者超声测得四肢骨骼肌厚度与MRC评分相关性及对预后的预测ROC曲线分析

Correlation between skeletal muscle thickness of the extremities measured by ultrasound and MRC score in elderly ICU-AW patients and analysis of ROC curve for prognosis

目的探讨老年重症加强护理病房(intensive care unit,ICU)获得性肌无力(ICU-acquiredweakness,ICU-AW)患者超声测得四肢骨骼肌厚度与英国医学研究委员会(medical research council,MRC)量表评分相关性,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价其对预后的预测价值。方法选取我院老年ICU-AW患者60例作为研究组,另选取同期老年ICU接受机械通气无ICU-AW患者60例作为对照组,比较2组超声测得四肢骨骼肌厚度、MRC评分,分析四肢骨骼肌厚度与MRC评分的相关性,比较不同预后患者临床资料、四肢骨骼肌厚度、MRC评分,分析四肢骨骼肌厚度、MRC评分与老年ICU-AW患者预后的关系及预测预后的价值。结果研究组肱二头肌、桡侧腕屈肌、股四头肌、胫前屈肌厚度及MRC评分低于对照组(P<0.05);老年ICU-AW患者肱二头肌、桡侧腕屈肌、股四头肌、胫前屈肌厚度与MRC评分呈正相关(P<0.05);病死患者28 d时机械通气天数高于生存患者,肱二头肌、桡侧腕屈肌、股四头肌、胫前屈肌厚度及MRC评分均低于生存患者(P<0.05);肱二头肌、桡侧腕屈肌、股四头肌、胫前屈肌厚度及MRC评分均为老年ICU-AW患者预后保护性因素(P<0.05);MRC评分、肱二头肌、桡侧腕屈肌、股四头肌、胫前屈肌厚度预测老年ICU-AW患者预后为病死的曲线下面积(area under curve,AUC)分别为0.805、0.837、0.648、0.785、0.799,各指标联合预测的AUC最大,为0.873。结论老年ICU-AW患者四肢骨骼肌厚度与MRC评分呈正相关,四肢骨骼肌厚度与MRC评分联合在预测患者预后方面具有一定价值。

Objective To investigate the correlation between the skeletal muscle thickness of the extremities and the British Medical Research Council(MRC)scale scores in elderly patients with ICU-acquired myasthenia(ICU-AW)and to draw the receiver operating characteristic(ROC)curve to evaluateits predictive value for prognosis.Methods A total of 60 elderly ICU-AW patients in our hospital were selected as the research group,and 60 elderly ICU patients without ICU-AW who received mechanical ventilation during the same period were selected as the control group.The skeletal muscle thickness of the extremities measured by ultrasound,and MRC score were compared between two groups,and their correlation was analyzed.Clinical data,skeletal muscle thickness of the extremities,and MRC score of patients with different prognosis were compared,and the relationship between skeletal muscle thickness,MRC score and the prognosis of elderly ICU-AW patients as well as their value in predicting prognosis was analyzed.Results The thickness and MRC score of the biceps brachii,flexor carpi radialis,quadriceps femoris,and tibialis anterior in the research group were lower than those in the control group(P<0.05).The thickness ofthe biceps brachii,flexor carpi radialis,quadriceps femoris,and tibialis anterior was positively correlated with the MRC score(P<0.05).The number of days of mechanical ventilation at 28 d in the deceased was higher than that of surviving patients,while the thickness of the biceps brachii,flexor carpi radialis,quadriceps femoris,and tibialis anterior and MRC score were lower than those of surviving patients(P<0.05).The thickness of the biceps brachii,flexor carpi radialis,quadriceps femoris,and tibialis anterior and MRC scores were all prognostic protective factors for elderly ICU-AW patients(P<0.05).The area under the curve(AUC)of MRC scores,the biceps brachii,flexor carpi radialis,quadriceps femoris,and tibialis anterior in predicting the prognosis of elderly ICU-AW patients was 0.805,0.837,0.648,0.785,and 0.799,respectively.The AUC of combined prediction of each index was the largest(0.873).Conclusion There is a positive correlation between the skeletal muscle thickness of the extremities and MRC score in elderly ICU-AW patients.The combination of skeletal muscle thickness of the extremities and MRC score has certain value in predicting the prognosis of patients.