小腿围、上臂围在慢性阻塞性肺疾病急性加重期合并肌少症患者中的筛查效能分析  

Analysis of screening efficacy of calf circumference and upper arm circumference in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with sarcopenia

作　　者：田凤 岳红梅[1,2] 陈东津[1] 秦亚茹 马媛媛 TIAN Feng;YUE Hongmei;CHEN Dongjin;QIN Yaru;MA Yuanyuan(The First Clinical Medical College of Lanzhou University,Lanzhou,Gansu 730000,China;Department of Respiratory and Critical Care Medicine,The First Hospital of Lanzhou University,Lanzhou,Gansu 730000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院呼吸与危重症医学科,甘肃兰州730000

出　　处：《临床肺科杂志》2025年第4期543-549,共7页Journal of Clinical Pulmonary Medicine

基　　金：甘肃省科技计划(18YF1FA106);甘肃省科技计划(20YF2FA007);甘肃省科技计划(科技重大专项计划)(22ZD1FA001)。

摘　　要：目的评价小腿围、上臂围在AECOPD患者合并肌少症筛查中的可靠性,为肌少症筛查提供适用性工具。方法采用便利取样选取2023年10月16日至2024年5月27日就诊于兰州大学第一医院呼吸与危重症医学科的年龄≥40岁的AECOPD患者共90例,排除胸部CT L1层面图像质量不佳的患者18例,最终纳入72例患者。将患者的胸部CT L1层面导入到Slice-O-Matic软件,进行骨骼肌面积的测量,同时进行上臂围、小腿围、握力等的测试。采用SPSS 27.0进行统计分析。结果上臂围、小腿围与握力、骨骼肌指数(skeletal muscle mass index,SMI)等指标均呈正相关(r s=0.401~0.831,P<0.01)。总体来看,小腿围(r s=0.546~0.612,P<0.001)与握力、SMI的相关性高于上臂围(r s=0.435~0.490,P<0.001)。在男性患者中,小腿围(r s=0.469~0.528,P<0.001)与握力、SMI的相关性也高于上臂围(r s=0.401~0.510,P<0.01)。女性患者中,小腿围(r s=0.692~0.831,P<0.001)与肌肉量指标的相关性同样高于上臂围(r s=0.582~0.665,P<0.01)。并且女性患者中小腿围与SMI(r s=0.831,P<0.001)相关系数最高,为高度相关。ROC曲线显示:在AECOPD男性患者中,小腿围、上臂围及两者联合对肌少症筛查的AUC分别是:0.884(95%CI:0.788~0.980)、0.751(95%CI:0.611~0.890)和0.883(95%CI:0.787~0.979),小腿围、上臂围的最佳截断值分别为34.15cm(敏感度0.818,特异度1.00)和26.20cm(敏感度0.697,特异度0.800)。两者联合筛查的敏感度(0.818)、特异度(1.000)均与小腿围完全相同。在AECOPD女性患者中,小腿围、上臂围及两者联合对肌少症筛查的AUC分别是:0.992(95%CI:0.967~1.000)、0.789(95%CI:0.595~0.983)和0.992(95%CI:0.967~1.000),小腿围、上臂围的最佳截断值分别为32.05cm(敏感度1.000,特异度0.937)和24.35cm(敏感度0.625,特异度0.875)。两者联合筛查的敏感度(1.000)、特异度(0.937)均与小腿围完全相同。结论在AECOPD合并肌少症患者中,小腿围、上臂围均表现出了较好地筛查效�Objective To evaluate the reliability of calf circumference and upper arm circumference in screening for sarcopenia in patients with acute exacerbation of chronic obstructive pulmonary disease,and to provide applicable tools for sarcopenia screening.Methods Convenient sampling was used to select a total of 90 AECOPD patients aged≥40 years who visited the Department of Respiratory and Critical Care Medicine at Lanzhou University First Hospital from October 16,2023 to May 27,2024.18 patients with poor chest CT L1 image quality were excluded,and 72 patients were ultimately included.The patient′s chest CT L1 plane was imported into the Slice-O-Matic software for measurement of skeletal muscle area,as well as testing of upper arm circumference,calf circumference and grip strength.Statistical analysis was conducted by SPSS 27.0.Results The upper arm circumference and calf circumference were positively correlated with grip strength and skeletal muscle mass index(SMI)(r s=0.401-0.831,P<0.01).Overall,the correlation between calf circumference(r s=0.546-0.612,P<0.001)and grip strength,SMI was higher than that between upper arm circumference(r s=0.435-0.490,P<0.001).Looking at male patients alone,the correlation between calf circumference(r s=0.469-0.528,P<0.001)and grip strength,SMI was also higher than that of upper arm circumference(r s=0.401-0.510,P<0.01).Looking at female patients alone,the correlation between calf circumference(r s=0.692-0.831,P<0.001)and muscle mass index was also higher than that of upper arm circumference(r s=0.582-0.665,P<0.01).and the correlation coefficient between calf circumference and SMI(r s=0.831,P<0.001)was the highest in female patients,indicating a high degree of correlation.The ROC curve showed that in male AECOPD patients,the AUC of calf circumference,upper arm circumference,and their combination for screening muscle atrophy were 0.884(95%CI:0.788-0.980),0.751(95%CI:0.611-0.890)and 0.883(95%CI:0.787-0.979),respectively.The optimal cutoff values for calf circumference and upper arm

关 键 词：慢性阻塞性肺疾病急性加重期 肌少症 小腿围 上臂围 骨骼肌指数 

分 类 号：R563.9[医药卫生—呼吸系统] R685[医药卫生—内科学]