超声测量髂腰肌横截面积在老年2型糖尿病肌少症诊断中应用价值分析

目的： 探究超声测量指标髂腰肌横截面积（Cross Sectional Area,CSA）在诊断老年（≥65岁）2型糖尿病（Type 2 diabetes mellitus,T2DM）肌肉减少症（简称：肌少症）中的应用价值。方法：选取自贡市第四人民医院2022年11月至2023年5月间的133例确诊的老年T2DM患者作为观察组,根据肌少症的诊断标准,采用生物电阻抗分析法测量的四肢骨骼肌质量（Appendicular skeletal muscle mass,ASM）和手持式握力计测量的握力（Handgrip strength,HGS）值作为判断指标,将研究对象划分为肌少症组和无肌少症组。随后,通过超声技术测量并记录两组成员的髂腰肌横截面积（Cross sectional area, CSA）、DFY软件测量髂腰肌平均灰度和声强。利用单因素分析寻找与有无肌少症存在联系的关键变量,随后构建多变量Logistic回归模型（逐步法）揭示肌少症发生的独立危险因素,并将有意义的指标纳入回归模型,采用灵敏度、特异度、准确率、AUC判断诊断肌少症的应用价值。最后通过Pearson相关分析CSA与ASM、HGS的关联性。结果：肌少症组和无肌少症组患者的年龄、髂腰肌平均灰度和声强无明显差异（P >0.05）,BMI和超声髂腰肌CSA组间差异具有统计学意义（P <0.01）,肌少症人群BMI和超声髂腰肌CSA更低,其中男性超声髂腰肌CSA分别为5.85 ± 1.73cm2,7.51 ± 1.74cm2,女性分别为4.51 ± 0.93cm2,5.76 ± 1.30cm2;Logistic回归模型显示BMI（OR=0.852,P =0.036）、超声髂腰肌CSA（OR=0.593,P =0.001）是肌少症发生的保护因素;CSA、BMI、CSA+BMI分别纳入回归模型诊断肌少症,BMI断肌少症灵敏度、特异度、准确率、AUC分别为53.8%、74.2%、72.2%、0.656;CSA诊断肌少症灵敏度、特异度、准确率、AUC分别为64.7%、78.6%、74.7 %、0.723;BMI联合CSA诊断肌少症灵敏度、特异度、准确率、AUC分别为62.4%、81.2%、75.9%、0.753,联合模型效果较为理想;CSA与ASM（r=0.53,P <0.01）、HGS（r=0.55,P <0.01）均存在相关,其中CSA与ASM的相关性女性（r = 0.50, P < 0.01）高于男性（r = 0.30, P < 0.05）,CSA与HGS的相关性男性（r=0.40, P <0.01）高于女性（r = 0.30, P <0.01）。结论：超声测量髂腰肌CSA可能是一个在诊断老年T2DM肌少症中很高价值的参数,有助于评估肌肉质量、筛查肌少症。

The value of ultrasonic measurement of iliopsoas muscle cross-sectional area in the diagnosis of type 2 diabetes myopenia in the elderly

Purpose: To explore the application value of ultrasound measurement of the cross-sectional area (CSA) of the iliac psoas muscle in diagnosing muscle mass loss in elderly (≥65 years old) type 2 diabetes mellitus (T2DM) patients.Methods: A total of 133 confirmed elderly T2DM patients from Zigong Fourth People''s Hospital between November 2022 and May 2023 were selected as the observation group. According to the diagnostic criteria for MML, appendicular skeletal muscle mass (ASM) measured by bioelectrical impedance analysis and handgrip strength (HGS) measured by a handheld dynamometer were used as indicators. The study subjects were divided into MML group and non-MML group. Subsequently, the cross-sectional area of the iliopsoas muscle of the two groups of members was measured and recorded using ultrasound technology, and the average grayscale and sound intensity of the iliopsoas muscle were measured using DFY software.Key variables related to the presence of MML were identified using univariate analysis (t-test/chi-square test), followed by the construction of a multivariate logistic regression model (stepwise method) to reveal the independent risk factors for MML. The application value of meaningful indicators in diagnosing MML were assessed using sensitivity, specificity, accuracy, and area under the curve (AUC). Pearson correlation analysis was performed to evaluate the association between CSA and ASM, HGS.Results:There was no significant difference in age, average grayscale, and sound intensity of the iliopsoas muscle between the myopenia group and the non myopenia group (P > 0.05),but there were statistically significant differences in BMI and ultrasound CSA of the iliac psoas muscle between the two groups (P < 0.01). The MML group had lower BMI and ultrasound CSA of the iliac psoas muscle, with CSA values of 5.85 ± 1.73 cm2 for males and 7.51 ± 1.74 cm2 for females, and 4.51 ± 0.93 cm2 for males and 5.76 ± 1.30 cm2 for females. The logistic regression model showed that BMI (OR=0.852, P=0.036) and ultrasound area (OR=0.593, P=0.001) were protective factors for MML. CSA, BMI, and CSA+BMI were included in the regression model for diagnosing sarcopenia, respectively. The sensitivity, specificity, accuracy, and AUC of BMI sarcopenia were 53.8%, 74.2%, 72.2%, and 0.656, respectively; The sensitivity, specificity, accuracy, and AUC of CSA in diagnosing sarcopenia were 64.7%, 78.6%, 74.7%, and 0.723, respectively; The sensitivity, specificity, accuracy, and AUC of BMI combined with CSA in diagnosing sarcopenia were 62.4%, 81.2%, 75.9%, and 0.753, respectively. The combined model had an ideal effect.There was a significant correlation between CSA and ASM (r=0.53, P<0.01), as well as between CSA and HGS (r=0.55, P<0.01). The correlation between CSA and ASM was higher in females (r=0.50, P<0.01) than in males (r=0.30, P<0.05), while the correlation between CSA and HGS was higher in males (r=0.40, P<0.01) than in females (r=0.30, P<0.01).Conclusion: Ultrasound measurement of CSA of the iliac psoas muscle may be a highly valuable parameter in diagnosing MML in elderly T2DM patients, and it can help assess muscle mass and screen for MML.