Salim Saad Y, Al-Khathiri Omar, Tandon Puneeta, Baracos Vickie E, Churchill Thomas A, Warkentin Lindsey M, Khadaroo Rachel G
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; The Centre of Excellence for Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, Alberta, Canada.
Department of Gastroentrology, University of Alberta, Edmonton, Alberta, Canada.
J Surg Res. 2020 Dec;256:422-432. doi: 10.1016/j.jss.2020.06.043. Epub 2020 Aug 11.
Computed tomography (CT) scan quantifying skeletal muscle mass is the gold standard tool to identify sarcopenia. Unfortunately, high cost, limited availability, and radiation exposure limit its use. We suggest that ultrasound of the thigh muscle could be an objective, reproducible, portable, and risk-free tool, used as a surrogate to a CT scan, to help identify frail patients with sarcopenia.
We included 49 patients over 64 y old, referred to the acute care surgery service. An ultrasound of thigh muscle thickness was standardized to patient thigh length (U/S). CT skeletal muscle index (SMI) was calculated using skeletal muscle surface area of the L3 region divided by height. Frailty status was assessed using the Canadian Study of Healthy Aging Clinical Frailty Scale.
The mean (SD) age was 76 (8) y, and 34% (n = 17) were men. CT-defined sarcopenia was identified in 65% (n = 11) of men and 75% (n = 24) of women. In general, women had longer stay in hospital than men (mean + SD 14 ± 9 versus 7 ± 3 d, P = 0.003). There was a significant positive correlation between thigh U/S and CT SMI. There was an inverse correlation between thigh U/S and frailty score; a similar relationship was observed between CT SMI and frailty. There was an association between U/S and postoperative major complications.
This prospective observational study illustrates that the U/S index can be used as a surrogate to CT scan, whereby it can identify elderly frail patients with sarcopenia. Thigh ultrasound should be further tested as an objective tool to assess for stratifying frailty.
计算机断层扫描（CT）扫描定量骨骼肌质量是识别肌肉减少症的金标准工具。不幸的是，高成本、可用性有限和辐射暴露限制了其应用。我们认为，大腿肌肉超声检查可以作为一种客观、可重复、便携且无风险的工具，作为CT扫描的替代方法，以帮助识别患有肌肉减少症的虚弱患者。
我们纳入了49名64岁以上转诊至急性护理外科服务的患者。将大腿肌肉厚度的超声检查标准化为患者大腿长度（超声）。CT骨骼肌指数（SMI）通过L3区域的骨骼肌表面积除以身高来计算。使用加拿大健康老龄化临床虚弱量表评估虚弱状态。
平均（标准差）年龄为76（8）岁，34%（n = 17）为男性。65%（n = 11）的男性和75%（n = 24）的女性被CT诊断为肌肉减少症。总体而言，女性住院时间比男性长（平均 + 标准差 14 ± 9天对7 ± 3天，P = 0.003）。大腿超声与CT SMI之间存在显著正相关。大腿超声与虚弱评分之间呈负相关；CT SMI与虚弱之间也观察到类似关系。超声与术后主要并发症之间存在关联。
这项前瞻性观察性研究表明，超声指数可作为CT扫描的替代方法，从而能够识别患有肌肉减少症的老年虚弱患者。大腿超声应作为评估虚弱分层的客观工具进行进一步测试。
