肱二头肌超声参数联合临床资料诊断慢性肾脏病患者蛋白质能量消耗的临床价值  

Clinical value of ultrasound parameters of musculus biceps brachii combined with clinical data in diagnosing protein energy wasting in patients with chronic kidney disease

作　　者：马彧靓 何正中 赵琳 阚艳敏 周燕[1] 经翔[1] 王洪玲[4] MA Yuliang;HE Zhengzhong;ZHAO Lin;KAN Yanmin;ZHOU Yan;JING Xiang;WANG Hongling(Department of Ultrasound,the Third Central Hospital of Tianjin,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院超声科,300170 [2]天津市重症疾病体外生命支持重点实验室 [3]天津市人工细胞工程技术研究中心 [4]天津市第三中心医院肾内科,300170

出　　处：《临床超声医学杂志》2023年第5期400-404,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用超声测量肱二头肌相关定量参数,探讨其联合临床资料诊断慢性肾脏病(CKD)患者蛋白质能量消耗(PEW)的临床价值。方法选取于我院肾内科血液净化中心接受血液透析治疗的CKD患者83例,其中未合并PEW者18例(对照组),合并PEW者65例(异常组);比较两组临床资料及肱二头肌超声定量参数的差异;应用多因素Logistic回归分析CKD患者PEW的独立影响因素,并建立联合诊断模型;绘制受试者工作特征(ROC)曲线分析该模型预测CKD患者PEW的诊断效能。结果两组体质量指数(BMI)、透析前血肌酐(Cr)、肱三头肌皮褶厚度(TSF)、上臂中段肌围(AMC),以及超声所测肱二头肌舒张状态纵径、舒张状态面积、舒张状态与收缩状态纵径比值比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,BMI、肱二头肌舒张状态与收缩状态纵径比值均为CKD患者发生PEW的独立影响因素(OR=0.733、9.028,均P<0.05)。建立联合诊断模型为:Logit(P)=1[/1+e^(-(8.228-0.310×BMI+2.200×肱二头肌舒张状态与收缩状态纵径比值<0.964))],其预测CKD患者PEW的曲线下面积为0.856(95%可信区间:0.756~0.957,P<0.05)。结论超声所测肱二头肌舒张状态与收缩状态纵径比值可以明确CKD患者肌肉萎缩情况,联合BMI构建的Logistic诊断模型对诊断CKD患者PEW具有一定临床价值。Objective To explore the clinical value of ultrasound quantitative parameters of musculus biceps brachii combined with clinical data in diagnosing protein energy wasting(PEW)in patients with chronic kidney disease(CKD).Methods Eighty-three patients with CKD who received hemodialysis treatment in the blood purification center of nephrology department of our hospital were selected,including 18 non-PEW patients(control group)and 65 PEW patients(abnormal group).Clinical data and ultrasound quantitative parameters of musculus biceps brachii were compared between the two groups.The independent influencing factors of PEW in CKD patients were screened by multi-factor Logistic regression analysis.Logistic regression model was established as well.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of the model in predicting the occurrence of PEW in CKD patients.Results There were statistically significant differences in body mass index(BMI),blood creatinine(Cr),triceps skin fold(TSF),arm muscle circumference(AMC)and ultrasonically measured longitudinal diameter and area of musculus biceps brachii at relaxed state,relaxed to contracted state longitudinal diameter ratio(all P<0.05).Multi-factor Logistics regression analysis showed that BMI and relaxed to contracted state longitudinal diameter ratio of musculus biceps brachii were independent influencing factors for the occurrence of PEW(OR=0.733,9.028,both P<0.05).The joint diagnostic model was established.Logi(t P)=1[/1+e^(-(8.228-0.310×BMI+2.200×relaxed to contracted state longitudinal diameter ratio of musculus biceps brachii<0.964))].The area under the curve for predicting the occurrence of PEW in CKD patients was 0.856(95%CI:0.756~0.957,P<0.05).Conclusion The measurement of the relaxed to contracted state longitudinal diameter ratio of musculus biceps brachii by ultrasound can clarify the muscular atrophy in patients with CKD.The Logistic model constructed by relaxed to contracted state longitudinal diameter ratio of musculus biceps b

关 键 词：超声检查 肌骨 肱二头肌 蛋白质能量消耗 慢性肾脏病 血液透析 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692[医药卫生—诊断学]