4种肌少症筛查工具对老年慢性阻塞性肺疾病肌少症诊断效能比较

Comparison of diagnostic efficacy of four sarcopenia screening tools for sarcopenia in elderly COPD patients

目的:评估肌少症五条目(SARC-F)、改良版肌少症五条目(SARC-CalF)、迷你肌少症风险评估(MSRA)及Ishii评分4种筛查工具对老年慢性阻塞性肺疾病(COPD)病人肌少症的诊断效能。方法:选取2019年1月—2023年7月于我院住院的168例老年COPD病人作为研究对象。以亚洲肌少症工作组(AWGS)共识为“金标准”,分别估算SARC-F、SARC-CalF、MSRA和Ishii评分诊断老年COPD病人肌少症的敏感度、特异度、阳性预测值和阴性预测值,并绘制受试者工作特征(ROC)曲线,计算ROC下面积(AUC),并根据最大约登指数确定各筛查工具的最佳截断值。结果:168例老年COPD病人中,肌少症发生率为25.6%。使用SARC-F、SARC-CalF、MSRA和Ishii评分4种筛查工具诊断肌少症的发生率分别为16.7%、32.7%、48.2%和39.3%,阳性预测值38.27%~63.64%,阴性预测值为79.29%~92.92%,敏感度为32.56%~81.40%,特异度为60.00%~88.80%。ROC曲线分析显示,SARC-CalF的AUC最高,为0.925,最佳诊断界值为≥10分,此时诊断肌少症的敏感度和特异度分别为83.7%和95.2%,优于其他筛查工具。结论:SARC-F、SARC-CalF、MSRA和Ishii评分4种筛查工具对老年COPD病人肌少症均有一定诊断效能,但SARC-CalF的诊断效能最优,具有较高的预测准确度、敏感度和特异度。

Objective:To evaluate the diagnostic efficacy of four screening tools:The Five Entries for Sarcopenia(SARC-F),the Modified Five Entries for Sarcopenia(SARC-CalF),Mini Sarcopenia Risk Assessment(MSRA)and Ishii score in the diagnosis of sarcopenia in elderly patients with chronic obstructive pulmonary disease(COPD).Methods:Totally 168 elderly COPD patients attending outpatient clinics in our hospital from January 2019 to July 2023 were selected as study subjects.Using the Asian Working Group for Sarcopenia(AWGS)consensus as the"gold standard",the sensitivity,specificity,and positivity of the SARC-F,SARC-CalF,MSRA,and Ishii scores for sarcopenia in elderly COPD patients were estimated.The sensitivity,specificity,positive predictive value and negative predictive value of SARC⁃F,SARC⁃CalF,MSRA and Ishii scores for sarcopenia in elderly COPD patients were estimated,ROC curves were plotted,the AUC was calculated,and the optimal cut-off value of each screening tool was determined based on the maximal Youden index.Results:Among 168 elderly COPD cases,the prevalence of sarcopenia according to AWGS criteria was 25.6%.The prevalence of sarcopenia using the four screening tools,SARC⁃F SARC⁃CalF,MSRA,and Ishii score,was 16.7%,32.7%,48.2%,and 39.3%,respectively,with a positive predictive value ranging from 38.27%to 63.64%and a negative predictive value ranging from 79.29%to 92.92%,with a sensitivity ranging from 32.56%to 81.40%,and specificity degree 60.00%to 88.80%.ROC curve analysis suggested that SARC⁃CalF had the highest AUC of 0.925 and the optimal diagnostic cut⁃off value of≥10 points,at which time the sensitivity and specificity for diagnosing sarcopenia were 83.7%and 95.2%,respectively,which were superior to other screening tools.Conclusion:The four screening tools,SARC⁃F,SARC⁃CalF,MSRA and Ishii score,have certain clinical value in the assessment of sarcopenia in elderly COPD patients,however,SARC⁃CalF has the best diagnostic efficacy with high predictive accuracy,sensitivity and specificity.