Matsuzawa Ryota, Yamamoto Shohei, Suzuki Yuta, Imamura Keigo, Harada Manae, Matsunaga Atsuhiko, Tamaki Akira, Fukui Takayuki, Shimokado Kiyoshi
Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan.
Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
Clin Nutr. 2021 Mar;40(3):1161-1167. doi: 10.1016/j.clnu.2020.07.025. Epub 2020 Aug 1.
BACKGROUND & AIMS: We examined the validity of ultrasound technique assessing muscle mass and reflecting muscle strength and physical performance, and the clinical applicability of ultrasound as a diagnostic tool of sarcopenia in patients on hemodialysis.
This study included outpatients who were undergoing maintenance hemodialysis 3-time a week. Muscle mass, muscle strength and physical performance were assessed at the time of the patients' entry into the study. Ultrasound technique and bioelectrical impedance analysis (BIA) were used to estimate muscle mass. The cross-sectional area (CSA) of the rectus femoris was calculated using an ultrasound device built-in planimeter.
A total of 58 hemodialysis patients were included in the analyses. Ultrasound-derived muscle mass was strongly correlated with BIA-derived measurements and independently associated with handgrip strength (β = 4.22, 95% confidence interval [CI] = 2.23-6.20, P < 0.001), gait speed (β = 0.15, 95% CI = 0.05-0.26, P = 0.006), chair stand time (β = -4.33, 95% CI = -7.34 to -1.31, P = 0.006), and SPPB score (β = 1.81, 95% CI = 0.46-3.15, P = 0.010) even after adjustment of patient characteristics. The discrimination ability of CSA of rectus femoris for muscle loss was high. Of the patients who were diagnosed with sarcopenia by the ultrasound-based criteria, 96% met the BIA-based criteria.
Ultrasound identified the patients at higher risk of skeletal muscle loss and sarcopenia with good discriminatory power. Ultrasound could be a valid and feasible technique for dialysis populations in clinical settings.
我们研究了超声技术评估肌肉质量、反映肌肉力量和身体机能的有效性，以及超声作为血液透析患者肌肉减少症诊断工具的临床适用性。
本研究纳入每周进行3次维持性血液透析的门诊患者。在患者入组研究时评估其肌肉质量、肌肉力量和身体机能。采用超声技术和生物电阻抗分析（BIA）评估肌肉质量。使用超声设备内置的面积测量仪计算股直肌的横截面积（CSA）。
共58例血液透析患者纳入分析。超声测得的肌肉质量与BIA测得的结果高度相关，并且在调整患者特征后，与握力（β = 4.22，95%置信区间[CI] = 2.23 - 6.20，P < 0.001）、步速（β = 0.15，95% CI = 0.05 - 0.26，P = 0.006）、从椅子上站起的时间（β = -4.33，95% CI = -7.34至-1.31，P = 0.006）以及简易体能状况量表（SPPB）评分（β = 1.81，95% CI = 0.46 - 3.15，P = 0.010）独立相关。股直肌CSA对肌肉量减少的鉴别能力较高。根据基于超声的标准诊断为肌肉减少症的患者中，96%符合基于BIA的标准。
超声能够很好地鉴别出骨骼肌量减少和肌肉减少症风险较高的患者。超声可能是临床环境中用于透析人群的一种有效且可行的技术。
