二维超声、剪切波弹性成像联合肾功能指标诊断2型糖尿病合并肌少症的临床价值  

Clinical value of two-dimensional ultrasound and shear wave elastography combined with renal functional indexes in the diagnosis of type 2 diabetes mellitus complicated with sarcopenia

作　　者：单思维 林媛 吴俊峰 韩韬[1] SHAN Siwei;LIN Yuan;WU Junfeng;HAN Tao(Department of Ultrasound Medicine,Suqian Zhongwu Hospital,Suqian 223800,China)

机构地区：[1]宿迁市钟吾医院超声医学科,江苏宿迁223800

出　　处：《临床超声医学杂志》2025年第1期70-75,共6页Journal of Clinical Ultrasound in Medicine

基　　金：宿迁市2023年度市级指导性科技计划项目(Z202367)。

摘　　要：目的探讨二维超声、剪切波弹性成像(SWE)联合肾功能指标诊断2型糖尿病(T2DM)合并肌少症的临床价值。方法选取于我院就诊的T2DM患者112例,根据是否合并肌少症将其分为T2DM未合并肌少症组88例和T2DM合并肌少症组24例;另选同期健康老年人75例为健康对照组。应用二维超声测量右侧腓肠肌内侧头肌肉厚度、羽状角及肌束长度;SWE测量腓肠肌剪切波速度(SWV);收集临床资料,包括血压、体质量指数、空腹血糖、糖化血红蛋白(HbA1c)及肾功能指标[肌酐、尿酸、尿素氮、24 h尿蛋白和估算肾小球滤过率(eGFR)]。比较各组上述参数的差异;采用多因素Logistic回归分析筛选预测T2DM合并肌少症的影响因素;绘制受试者工作特征(ROC)曲线评估各影响因素联合应用对T2DM合并肌少症的诊断效能。结果各组空腹血糖、HbA1c、肌酐、24 h尿蛋白、eGFR、肌肉厚度、肌束长度及SWV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,以健康对照组为参照,肌肉厚度、SWV及eGFR均为预测T2DM合并肌少症的独立影响因素(均P<0.05),由此建立回归方程:Logit(P)=-4.178+3.607×eGFR-0.262×肌肉厚度+1.148×SWV;以T2DM未合并肌少症组为参照,肌肉厚度、SWV及eGFR均为预测T2DM合并肌少症的独立影响因素(均P<0.05),由此建立回归方程:Logit(P)=2.293-0.213×eGFR-2.639×肌肉厚度-2.144×SWV。ROC曲线分析显示,以健康对照组为参照,肌肉厚度、SWV联合eGFR诊断T2DM合并肌少症的曲线下面积为0.936,灵敏度为83.3%,特异度为90.9%;以T2DM未合并肌少症组为参照,肌肉厚度、SWV联合eGFR诊断T2DM合并肌少症的曲线下面积为0.905,灵敏度为91.7%,特异度为79.8%。结论二维超声、SWE联合肾功能指标在诊断2型糖尿病合并肌少症中具有良好的临床价值,可为临床早期识别提供参考。Objective To explore the clinical value of two-dimensional ultrasound and shear wave elastography(SWE)combined with renal functional indexes in the diagnosis of type 2 diabetes mellitus(T2DM)complicated with sarcopenia.Methods A total of 112 patients with T2DM were selected from our hospital.According to whether complicated with sarcopenia,the patients were divided into 88 cases of T2DM without sarcopenia group and 24 cases of T2DM complicated with sarcopenia group.Meanwhile,75 healthy elderly participants were selected as the healthy control group.The muscle thickness,feathery angle and muscle bundle length of the medial head of the right gastrocnemius were measured by two-dimensional ultrasound.Shear wave velocity(SWV)of gastrocnemius muscle was measured by SWE.Clinical data including blood pressure,body mass index,fasting blood glucose,hemoglobin A1c(HbA1c),and renal functional indexes[serum creatinine,uric acid,urea nitrogen,24 h urinary protein and estimated glomerular filtration rate(eGFR)]were collected.The differences of the above parameters among the groups were compared.Multivariate Logistic regression was used to analyze the influencing factors for predicting T2DM complicated with sarcopenia.Receiver operating characteristic(ROC)curve was dwawn to evaluate the diagnostic efficacy of the combined application of various influencing factors in T2DM complicated with sarcopenia.Results There were significant differences in fasting blood glucose,HbA1c,serum creatinine,24 h urinary protein,eGFR,muscle thickness,muscle bundle length and SWV among groups(all P<0.05).Multivariate Logistic regression analysis showed that taking the healthy control group as a reference,the muscle thickness,SWV of gastrocnemius and eGFR were independent influencing factors for predicting T2DM complicated with sarcopenia,the regression equation was as follows:Logit(P)=-4.178+3.607×eGFR-0.262×muscle thickness+1.148×SWV.Taking T2DM without sarcopenia group as a reference,the muscle thickness,SWV of gastrocnemius and the eGFR were i

关 键 词：超声检查 二维 剪切波弹性成像 2型糖尿病 肌少症 腓肠肌 

分 类 号：R445.1[医药卫生—影像医学与核医学] R587.1[医药卫生—诊断学]