多模态超声评估慢性心力衰竭患者骨骼肌状态价值研究

The value of multimodal ultrasound for quantitative evaluation of skeletal muscle in patients with chronic heart failure

目的 探讨灰阶超声及剪切波弹性成像评估慢性心力衰竭(CHF)患者骨骼肌状态的价值.方法 前瞻性纳入CHF患者50例,并选取同期健康体检者50例作为对照组,对所有受试者股直肌及腓肠肌内侧头进行灰阶超声及剪切波弹性成像,观察肌肉厚度、横截面积、肌束长度、羽状角、灰度值及杨氏模量值等参数.结果CHF组股直肌的厚度(7.80±2.01)mm、横截面积(3.27±0.91)cm^(2)、灰度值(70.07±6.06)及腓肠肌内侧头厚度(12.23±2.42)mm、肌束长度(35.90 ±1.38)mm、羽状角(18.07±3.05)度与对照组对比,差异有统计学意义[(12.90±2.57)mm、(4.94 ±2.08)cm2、60.93±9.77、(15.90±2.62)mm、(37.83±2.83)mm、(20.75±2.5)9 度,t=7.71、3.78、3.94、4.99、4.47、3.06,均P<0.01],而股直肌及腓肠肌内侧头的杨氏模量值均差异无统计学意义(t=1.10、0.51,P>0.05).CHF组按照美国纽约心脏病协会心功能分级(NYHA)分组,各组间股直肌的厚度、横截面积、灰度值均差异有统计学意义(F=56.36、69.98、55.96,P<O.01),而腓肠肌相关参数差异无统计学意义(P>0.05).CHF组按照左心室射血分数(LVEF)分组,各组间股直肌及腓肠肌超声参数均差异无统计学意义(P>0.05).结论 灰阶超声可以提供CHF患者骨骼肌状态的客观指标,从而指导临床早期康复训练以提高患者预后水平.

Objective To assess the usefulness of gray-scale ultrasonography and shear wave elastography in assessing the condition of skeletal muscle in people with chronic heart failure(CHF).Methods In this prospective study,there were 50 CHF patients and another 50 healthy people undergoing physical checkups served as the control group.The rectus femoris and the gastrocnemius medialis of all participants were evaluated by shear wave elastography and gray-scale ultrasonography.Data were collected using quantitative parameters including muscle thickness,cross-sectional area,fascicle length,pinnation angle,gray value and Young's modulus.Results Compared with the control group,the thickness(7.80±2.01)mm,cross-sectional area(3.27±0.91)cm^(2) and gray value(70.07±6.06)of the rectus femoris and the thickness(12.23±2.42)mm,fascicle length(35.90±1.38)mm and pinnation angle(18.07±3.05)degrees of the gastrocnemius medialis in the CHF group were statistically different[(12.90±2.57)mm,(4.94±2.08)cm^(2),60.93±9.77]for the rectus femoris and(15.90±2.62)mm,(37.83±2.83)mm,(20.75±2.59)degrees for the gastrocnemius medialis of the control group,t=7.71,3.78,3.94,4.99,4.47,3.06,P<0.01,but there was no significant difference in Young's modulus of the rectus femoris and the gastrocnemius medialis between the two groups(t=1.10,0.51,P>0.05).In the CHF group,the thickness,cross-sectional area and gray value of the rectus femoris in different New York Heart Association(NYHA)heart failure grades were statistically different(F=56.36,69.98,55.96,P<0.01),but no difference was found in the gastrocnemius medialis with the same ultrasound parameters(P>0.05).When participants in the CHF group was divided into subgroups based on left ventricular ejection fraction(LVEF),there was no significant difference between the subgroups in values of the ultrasonic parameters for the rectus femoris and the gastrocnemius(P>0.05).Conclusions Gray-scale ultrasound may quantitatively evaluate the skeletal muscle of CHF patients to guide early rehabilitation training to improve their prognosis.