超声测量髂腰肌横截面积诊断老年2型糖尿病肌少症的临床价值

Clinical value of ultrasound measurement of iliopsoas muscle cross-sectional area in the diagnosis of sarcopenia in elderly patients with type 2 diabetes mellitus

目的应用超声测量髂腰肌横截面积(CSA),探讨其在老年2型糖尿病(T2DM)肌少症诊断中的临床应用价值。方法选取我院确诊的老年T2DM患者133例,其中肌少症组38例、无肌少症组95例。使用生物电阻抗分析法测量四肢骨骼肌质量(ASM),手持式握力测量仪测量握力(HGS);应用常规超声测量髂腰肌CSA,DFY软件测量髂腰肌平均灰阶值和分贝值,比较两组一般资料及髂腰肌CSA、平均灰阶值和分贝值的差异;分析髂腰肌CSA与ASM、HGS的相关性。采用多因素Logistic回归分析筛选老年T2DM患者肌少症的独立影响因素,并构建诊断模型。绘制受试者工作特征(ROC)曲线、校准曲线及临床决策曲线分别评估模型的区分度、校准度、临床收益。结果肌少症组患者体质量指数(BMI)和髂腰肌CSA均低于非肌少症组,差异均有统计学意义(均P<0.05);两组平均灰阶值和分贝值比较差异均无统计学意义。相关性分析显示,所有患者髂腰肌CSA与ASM和HGS均呈正相关(r=0.55、0.53,均P<0.01);男性患者髂腰肌CSA与ASM和HGS均呈正相关(r=0.30、0.40,均P<0.05);女性患者髂腰肌CSA与ASM和HGS均呈正相关(r=0.50、0.30,均P<0.01)。多因素Logistic回归分析显示BMI、髂腰肌CSA均为老年T2DM患者肌少症的独立影响因素(OR=0.852、0.593,P=0.036、0.001);建立诊断模型为:Logit(P)=-0.160×BMI-0.522×髂腰肌CSA+5.881。ROC曲线分析显示,模型诊断老年T2DM患者肌少症的灵敏度、特异度、准确率分别为62.4%、81.2%、75.9%,曲线下面积为0.753;校准曲线显示实际概率与预测概率之间校准度良好;决策曲线显示根据该模型对肌少症患者进行干预可获得较高的临床收益。结论超声测量髂腰肌CSA在诊断老年T2DM肌少症中具有较高的临床应用价值。

Objective To measure the iliopsoas muscle cross-sectional area(CSA)by ultrasound,and to explore the application value in diagnosing sarcopenia in elderly type 2 diabetes mellitus(T2DM)patients.Methods A total of 133 elderly patients with T2DM diagnosed in our hospital were selected,including sarcopenia group(38 cases)and non sarcopenia group(95 cases).The appendicular skeletal muscle mass(ASM)was measured by bioelectrical impedance analysis,and the handgrip strength(HGS)was measured by handheld dynamometer.The conventional ultrasound was used to measure the iliopsoas muscle CSA,and the DFY software was used to measure the average gray scale value and decibel value of the iliopsoas muscle.The differences of the general data and the CSA,average gray scale value and decibel value of the iliopsoas muscle between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between the iliopsoas muscle CSA and ASM,HGS.Multivariate Logistic regression analysis was used to screen the independent influencing factors of sarcopenia in elderly patients with T2DM,and a diagnostic model was constructed.Receiver operating characteristic(ROC)curve,calibration curve and clinical decision curve were drawn to evaluate the discrimination,calibration and clinical benefits of the model,respectively.Results The body mass index(BMI)and the iliopsoas muscle CSA in the sarcopenia group were lower than those in the non sarcopenia group,and the differences were statistically significant(all P<0.05).There were no significant difference in the average gray scale value and decibel value of iliopsoas between the two groups.The correlation analysis showed that the iliopsoas muscle CSA was positively correlated with ASM and HGS in all patients(r=0.55,0.53,both P<0.01).The iliopsoas muscle CSA in male patients was positively correlated with ASM and HGS(r=0.30,0.40,both P<0.05),whick was positively correlated with ASM and HGS in female patients(r=0.50,0.30,both P<0.01).Multivariate Logistic regression analysis showed that BMI and the iliopsoas muscle CSA were independent influencing factors of sarcopenia in elderly T2DM patients(OR=0.852,0.593,P=0.036,0.001),the diagnostic model was established as follow:Logit(P)=-0.160×BMI-0.522×iliopsoas muscle CSA+5.881.ROC curve analysis showed that the sensitivity,specificity and accuracy of the model for diagnosing sarcopenia in elderly T2DM patients were 62.4%,81.2%and 75.9%,respectively,and the area under the curve was 0.753.The calibration curve showed that the calibration degree between the actual probability and the predicted probability was good.The decision curve showed that according to the diagnostic model,the intervention of sarcopenia patients could obtain higher clinical benefits.Conclusion Ultrasound measurement of iliopsoas muscle CSA has high clinical application value in the diagnosis of elderly T2DM sarcopenia.