超声评价老年肌肉减少症与膈肌厚度及呼吸功能相关性研究

Evaluation correlation between senile sarcopenia and diaphragm thickness and respiratory function in elderly by ultrasound

目的探讨老年肌肉减少症与膈肌厚度及呼吸功能的相关性。方法选择28例老年肌肉减少症患者(肌肉减少症组),其中男性15例,女性13例;年龄65~85岁,平均年龄79.50岁;吸烟史10例;糖尿病5例,高血压9例,骨质疏松11例,陈旧性心肌梗死8例,慢性心力衰竭2例;体脂率11.45%~16.76%,平均体脂率14.99%;身体质量指数(BMI)16.45~24.68 kg/m^(2),平均BMI 20.49 kg/m^(2)。同期另选择健康体检者85例(正常对照组),其中男性42例,女性43例;年龄65~85岁,平均年龄75.96岁;吸烟史32例;糖尿病13例,高血压21例,骨质疏松29例,陈旧性心肌梗死7例,慢性心力衰竭1例;体脂率11.58%~16.89%,平均体脂率14.65%;BMI 17.23~25.55 kg/m^(2),平均BMI 23.88 kg/m^(2)。采用常规超声测量平静呼气末功能剩余容量膈肌厚度(TDI_(FRC))、深吸气末用力肺活量厚度膈肌(TDI_(FVC))和深呼气末剩余容量膈肌厚度(TDIRV)及膈肌位移,并计算膈肌增厚率(DTF)。采用肺功能测定仪测定肺活量(FVC)、呼气流量峰值(PEF)、第1秒用力呼气容积占预计值百分比(FEV1)评估肺通气功能,采用最大吸气压(MIP)和吸气峰流速(PIF)评估吸气肌功能。采用单因素和多因素二元Logistic回归分析肌肉减少症与膈肌厚度及呼吸功能的相关性。结果肌肉减少症组患者四肢骨骼肌质量指数(ASMI)、优势手握力及肌肉功能均低于正常对照组[(7.82±1.96)kg/m^(2)vs(9.08±1.60)kg/m^(2)、167.007 N±23.830 N(17.03 kg±2.43 kg)vs 174.656 N±35.610 N(17.81 kg±3.57 kg)、(0.88±0.12)m/s vs(0.94±0.18)m/s。t=-3.077、-1.305、-1.712,P<0.05],TDIFRC、TDIFVC及DTF均小于正常对照组[(1.76±0.16)mm vs(1.93±0.41)mm、(1.92±0.51)mm vs(2.56±0.93)mm、(1.14±0.59)mm vs(1.78±0.97)mm、(45.63±1.31)%vs(46.94±2.80)%],FVC、PEF、FEV1、MIP均小于正常对照组[(69.49±7.77)%vs(72.64±4.39)%、(294.82±13.31)L/min vs(305.83±14.38)L/min、(66.40±8.16)%vs(69.71±5.18)%、(5.73±0.51)kPa vs(6.46±0.34)kPa],差异均具有统计学意义(P<0.05)。多因素二元Logistic回归分析结果显示,ASMI[比值比(OR)=2.210,95%可信区间(CI)1.316~3.711,P=0.003]、超声测量膈肌厚度参数TDIFVC(OR=0.045,95%CI 0.008~0.263,P=0.001)和TDIRV(OR=0.150;95%CI 0.036~0.627,P=0.009),以及肺功能参数MIP(OR=0.931,95%CI 0.875~0.991,P=0.025)及PEF(OR=0.924;95%CI 0.874~0.977,P=0.005)与老年肌肉减少症状态独立相关。结论老年肌肉减少症可能与膈肌厚度和呼吸功能下降有关。超声可通过测量膈肌厚度提示老年肌肉减少症患者可能发生肺功能受损,可为临床决策提供辅助诊断信息。

Objective To investigate correlation between senile sarcopenia and diaphragm thickness as well as respiratory function.Methods A total of 28 patients with sarcopenia were enrolled which included 15 males and 13 females,aged 65-85 years old with mean age of 79.50 years old;10 cases with smoking history;5 of diabetes mellitus,9 of hypertension,11of osteoporosis,8 of old myocardial infarction and 2 of chronic heart failure;body fat rate was 11.45%-16.76%with mean body fat rate of 14.99%;body mass index(BMI)was 16.45-24.68 kg/m^(2) with mean BMI of 20.49 kg/m^(2).In the same period,85 healthy subjects were enrolled as normal control group,which included 42 males and 43 females,aged 65-85 years old with mean age of 75.96 years old,32 cases with smoking history,13 of diabetes mellitus,21 of hypertension,29 of osteoporosis,7 of old myocardial infarction and 1 of chronic heart failure;body fat rate was 11.58%-16.89%with mean body fat rate of 14.65%;BMI was 17.23-25.55 kg/m^(2) with mean BMI of 23.88 kg/m^(2).The conventional ultrasound was used to measure diaphragmatic thickness and diaphragmatic displacement in the resting end-expiratory thickness of di-aphragmatic at functional residual capacity(DIFRC),thickness of diaphragmatic at forced vital capacity(TDI_(FVC))and thickness of diaphragmatic at residual volume(TDI_(RV)),and the diaphragm thickening rate(DTF)was calculated.The forced vital capacity(FVC),peak expiratory flow(PEF)and forced expiratory volume in 1 second(FEV1)were measured by pulmonary function tester to evaluate pulmonary ventilation function.The inspiratory muscle function was evaluated by maximum inspiratory pressure(MIP)and peak inspiratory flow(PIF).The univariate and multivariate binary Logistic regression were used to analyze the correlation between sarcopenia and diaphragm thickness and respiratory function.Results The appendicular skeletal muscle mass index(ASMI),dominant hand grip strength and muscle function in sarcopenia group were statistically significantly lower than those in normal control group[(7.82±1.96)kg/m^(2)vs(9.08±1.60)kg/m^(2),167.007 N±23.830 N(17.03 kg±2.43 kg)vs 174.656 N±35.610 N(17.81 kg±3.57 kg),(0.88±0.12)m/s vs(0.94±0.18)m/s.t=-3.077,-1.305,-1.712,P<0.05],TDIFRC,TDI_(FVC)and DTF were lower than the normal control group[(1.76±0.16)mm vs(1.93±0.41)mm,(1.92±0.51)mm vs(2.56±0.93)mm,(1.14±0.59)mm vs(1.78±0.97)mm,(45.63±1.31)%vs(46.94±2.80)%],FVC,PEF,FEV1 and MIP were statistically significantly lower than the normal control group[(69.49±7.77)%vs(72.64±4.39)%,(294.82±13.31)L/min vs(305.83±14.38)L/min,(66.40±8.16)%vs(69.71±5.18)%,(5.73±0.51)kPa vs(6.46±0.34)kPa](P<0.05).The results of multivariate binary Logistic regression analysis showed that ASMI[odds ratio(OR)=2.210,95%confidence interval(CI)1.316-3.711,P=0.003],ultrasonic measurement of diaphragmatic thickness parameters TDI_(FVC)(OR=0.045,95%CI 0.008-0.263,P=0.001)and TDI_(RV)(OR=0.150,95%CI 0.036-0.627,P=0.009),pulmonary function parameter MIP(OR=0.931,95%CI 0.875-0.991,P=0.025)and PEF(OR=0.924,95%CI 0.874-0.977,P=0.005)were independently correlated with senile sarcopenia.Conclusion It is demonstrated that senile sarcopenia may be correlated with decreased diaphragm thickness and respiratory function,the ultrasound measures diaphragm thickness suggested that pulmonary function damage may occur in senile sarcopenia,which provide auxiliary diagnostic information for clinical practice.