背景:全国范围内,prospective,多中心,队列研究(疾病相关的热量-蛋白营养不良EChOgraphy(DRECO)研究)旨在评估股直肌超声在有营养不良风险的住院患者中检测肌肉减少症的有用性,并确定超声测量的临界值.
方法:根据营养不良通用筛查工具(MUST)有营养不良风险的患者接受了手握测力法,生物电阻抗分析(BIA)定时上行(TUG)测试,和股直肌超声研究。欧洲老年人肌肉减少症工作组(EWGSOP2)标准用于定义肌肉减少症的类别(处于危险中,可能,确认,严重)。受试者工作特征(ROC)和曲线下面积(AUC)分析用于确定最佳诊断灵敏度,特异性,以及用于检测肌肉减少症和可能的风险的超声措施的截止点的预测值,确认,和严重的肌肉减少症.
结果:共纳入1000名受试者,其中991名(58.9%为男性,平均年龄58.5岁)进行了评估。在9.6%的患者中检测到肌肉减少症的风险,14%可能的少肌症,确认为9.7%的肌少症,严重的肌少症占3.9%,男性和女性之间的群体分布存在显着差异(p<0.0001)。股直肌的横截面积(CSA)与BIA的体细胞质量和握力呈显着正相关,与TUG呈显著负相关。截断值在每个类别的肌少症中相似,CSA的范围在2.40cm2和3.66cm2之间,X轴32.57mm和40.21mm,和7.85毫米和10.4毫米的Y轴。总的来说,这些截止值显示出很高的敏感性,特别是对于确诊和严重的肌少症的类别,男性患者也比女性表现出更好的敏感性。
结论:营养不良风险住院患者的肌肉减少症高。建立了股直肌超声测量的更好敏感性和特异性的截止值。股直肌超声的使用可用于预测肌肉减少症,并有助于将营养研究纳入实际临床实践。
BACKGROUND: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures.
METHODS: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia.
RESULTS: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women.
CONCLUSIONS: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.