常规超声联合剪切波弹性成像在慢性肾脏病患者肌肉减少症中的诊断价值

Diagnostic Value of Conventional Ultrasound Combined with Shear Wave Elastography for Sarcopenia in Patients with Chronic Kidney Disease

【目的】探讨常规超声联合剪切波弹性成像(SWE)在慢性肾脏病(CKD)患者肌肉减少症中的诊断价值。【方法】纳入94例CKD患者,其中34例为肌肉减少症患者,60例为非肌肉减少症患者。每位患者完成简易评分问卷(SARC-CalF)、微型营养评估量表(MNA)、简易功能评估测试(SPPB)、握力测试、生物电阻抗分析(BIA)及大腿肌肉的常规超声和SWE检测。分析两组各指标的差异,以Spearman相关分析观察常规超声及SWE与其他临床指标之间的相关性,筛选有效的肌肉减少症的诊断指标,并绘制受试者工作特征曲线,计算曲线下面积(AUC),观察各指标独立及联合应用评估CKD肌肉减少症的效能,运用二元Logistic回归分析CKD患者肌肉减少症的影响因素,并建立联合诊断模型。【结果】肌肉减少组的上臂围、小腿围、6米步速及握力均低于非肌肉减少症组,差异有统计学意义(P<0.05)。肌肉减少症组SARC-CalF评分及SPBB评分更低,营养状况更差。两组间的超声指标,包括皮下脂肪厚度、股直肌厚度、股直肌与股中间肌厚度之和、股直肌横截面积、股直肌弹性模量、股内侧肌弹性模量,均显示出有统计学意义的差异(P<0.05)。肌肉质量指数(SMI)与股直肌厚度及股直肌横截面积呈中度正相关(0.3<r≤0.6);50 kHz-下肢相位角与股直肌厚度有较高正相关性(0.6<r≤0.8),同时与股直肌横截面积、股直肌弹性模量、股内侧肌弹性模量及股外侧肌弹性模量均有中度正相关性(0.3<r≤0.6)。综合常规超声指标(皮下脂肪厚度、股直肌厚度、股直肌与股中间肌厚度之和、股直肌横截面积)诊断CKD肌肉减少症的AUC为0.823(95%CI:0.820,0.825)。综合SWE指标(股直肌弹性模量、股内侧肌弹性模量)诊断CKD肌肉减少症的AUC为0.724(95%CI:0.718,0.725)。有效的常规超声指标及SWE指标联合诊断的AUC为0.910(95%CI:0.908,0.912)。纳入除股内侧肌弹性模量之外的7个超声指标建立二元Logistic回归分析诊断模型,此时AUC为0.914(95%CI:0.913,0.916),灵敏度为0.952,特异度为0.808。【结论】常规超声联合SWE可作为检测CKD患者肌肉减少症的一种简单、有效的方法,为临床早期干预提供可靠依据。

【Objective】To explore the diagnostic value of conventional ultrasound combined with shear wave elastography(SWE)for sarcopenia in patients with chronic kidney disease(CKD).【Methods】The study included 94 CKD patients(34 with sarcopenia and 60 without).All patient underwent the Simplified Assessment Rating Questionnaire(SARC-CalF),Mini Nutritional Assessment(MNA),Short Physical Performance Battery(SPPB),grip strength test,bioelectrical impedance analysis(BIA),conventional muscle ultrasound and SWE of the thighs.We then compared the differences in indicators between the sarcopenia group and non-sarcopenia group,used Spearman correlation analysis to assess the relationship between the two examinations(conventional ultrasound and SWE)and other clinical indicators,identified the diagnostic markers for sarcopenia,created receiver operating characteristic(ROC)curves,calculated the area under the curve(AUC)and determined the diagnostic performance of conventional ultrasound,SWE and their combination.Binary logistic regression was used to analyze the influencing factors of sarcopenia in CKD patients and a combined diagnosis model was established.【Results】The sarcopenia group showed lower upper arm circumference,calf circumference,6-meter walking speed and handgrip strength than non-sarcopenia group,and the differences were statistically significant(P<0.05).The sarcopenia group exhibited lower SARC-CalF and SPBB scores,as well as more compromised nutritional status.Statistically significant differences were observed in the ultrasound parameters between the two groups,including thickness of the subcutaneous fat and rectus femoris,combined thickness of the rectus femoris and vastus intermedius,rectus femoris cross-sectional area,elastic modulus of the rectus femoris and vastus medialis(all P<0.05).The muscle mass index had a moderate positive correlation with muscle thickness and cross-sectional area of the rectus femoris(0.3<r≤0.6).The 50 kHz-leg phase angle was highly positively correlated with the rectus femoris muscle thickness(0.6<r≤0.8)and moderately positively correlated with the rectus femoris cross-sectional area,elastic modulus of the rectus femoris,vastus medialis and vastus lateralis(0.3<r≤0.6).The AUC of conventional ultrasound,SWE and their combination for diagnosis of sarcopenia in CKD patients were 0.823(95%CI:0.820,0.825),0.724(95%CI:0.718,0.725)and 0.910(95%CI:0.908,0.912),respectively.A predictive model incorporating seven indicators was established,with an AUC of 0.914(95%CI:0.913,0.916),a sensitivity of 0.952 and specificity of 0.808.【Conclusions】Conventional ultrasound combined with SWE can be used as a simple and effective method to detect sarcopenia in patients with CKD and provide a reliable basis for early clinical intervention.