小腿围和上臂围及Ishii评分对冠心病合并肌少症患者的诊断价值比较研究  

Comparison of the Diagnostic Value of Calf Circumference,Upper Arm Circumference and Ishii Score in Patients with Coronary Heart Disease Complicated with Sarcopenia

作　　者：罗琴 苟连平[1] 陈银 苏凤 LUO Qin;GOU Lianping;CHEN Yin;SU Feng(Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;The First Affiliated Hospital of Chengdu Medical College,Chengdu 610000,China)

机构地区：[1]川北医学院附属医院,四川省南充市637000 [2]成都医学院第一附属医院,四川省成都市610000

出　　处：《中国全科医学》2024年第35期4403-4411,共9页Chinese General Practice

摘　　要：背景肌少症作为一种常见老年慢性病,在冠心病(CHD)患者中有较高的患病率,其增加了跌倒、骨折等不良事件的发生风险,已有研究证实小腿围、上臂围及Ishii评分对肌少症筛查具有一定价值,但在冠心病人群中应用较少。目的评价小腿围、上臂围及Ishii评分在住院老年CHD合并肌少症筛查中的准确性及一致性。方法选取2023-01-01—05-31在川北医学院附属医院心内科治疗的213例CHD患者为研究对象,采用身体成分测试仪检测肌肉量及上臂围等指标,进行小腿围的测量,并同时计算Ishii评分。通过Spearman秩相关分析探究上臂围、小腿围及Ishii评分与肌肉量等指标的相关性,通过绘制受试者工作特征(ROC)曲线分析不同性别人群上臂围、小腿围及Ishii评分对肌少症的诊断效果,并确定最佳诊断截断值,计算Kappa值判断上臂围、小腿围及Ishii评分与《老年人肌少症防控干预中国专家共识(2023)》肌少症诊断标准结果的一致性。结果CHD患者合并肌少症的发生率为27.2%(58/213)。总人群上臂围、小腿围与四肢骨骼肌含量、四肢骨骼肌质量指数及握力均呈正相关(P<0.001),Ishii评分与四肢骨骼肌含量、四肢骨骼肌质量指数及握力呈负相关(P<0.001)。男性上臂围、小腿围与四肢骨骼肌含量、四肢骨骼肌质量指数及握力均呈正相关(P<0.001),Ishii评分与四肢骨骼肌含量、四肢骨骼肌质量指数及握力呈负相关(P<0.001)。女性上臂围、小腿围与四肢骨骼肌含量、四肢骨骼肌质量指数及握力均呈正相关(P<0.001),Ishii评分与四肢骨骼肌含量、四肢骨骼肌质量指数及握力呈负相关(P<0.001)。ROC曲线显示,男性小腿围诊断肌少症的最佳截断值为34.3 cm(灵敏度=86.5%,特异度=64.6%);女性小腿围诊断肌少症的最佳截断值为33.8 cm(灵敏度=100.0%,特异度=50.0%);男性上臂围诊断肌少症的最佳截断值为28.0cm(灵敏度=70.3%,特异度=85.9%);Background As a common geriatric chronic disease,sarcopenia has a high prevalence in patients with coronary heart disease(CHD),which increases the risk of adverse events such as falls and fractures,calf circumference,upper arm circumference,and Ishii score have been shown to be valuable in screening for sarcopenia,but are less commonly used in CHD patients.Objective To evaluate the accuracy and consistency of calf circumference,upper arm circumference,and Ishii score in screening for combined sarcopenia in hospitalized elderly patients with CHD.Methods A total of 213 CHD patients treated at the Department of Cardiology,Affiliated Hospital of North Sichuan Medical College from January 1,2023 to May 31,2023,were selected for the study,the body composition test instrument was used to detect indicators such as muscle mass and upper arm circumference,the measurement of calf circumference was performed,and Ishii score was calculated simultaneously.Spearman's rank correlation analysis was used to explore the correlation of upper arm circumference,calf circumference and Ishii score with indicators such as muscle mass,the diagnostic effect of upper arm circumference,calf circumference and Ishii score on sarcopenia in different people was analyzed by plotting receiver operating characteristic(ROC)curves,and the optimal diagnostic cut-off values were determined,which were calculated as Kappa values to determine the consistency of the upper arm circumference,calf circumference and Ishii score with the diagnostic criteria of sarcopenia according to the Chinese Expert Consensus(2023)Criteria for the Prevention and Treatment of Sarcopenia in the elderly.Results The prevalence of combined sarcopenia in CHD patients was 27.2%(58/213).In the whole population,upper arm circumference and calf circumference was positively correlated with appendicular skeletal muscle mass,appendicular skeletal muscle mass index,and grip strength(P<0.001),while Ishii score was negatively correlated with appendicular skeletal muscle mass,appendicular sk

关 键 词：冠心病 肌肉减少症 筛查 效度 小腿围 上臂围 Ishii评分 

分 类 号：R746.4[医药卫生—神经病学与精神病学]