Department of Oesophagogastric Surgery, Salford Royal NHS Foundation Trust, Salford, UK.
Division of Diabetes, Endocrinology and Gastroenterology, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
J Cachexia Sarcopenia Muscle. 2022 Oct;13(5):2298-2309. doi: 10.1002/jcsm.13041. Epub 2022 Jul 19.
Quantification and monitoring of lean body mass is an important component of nutrition assessment to determine nutrition status and muscle loss. The negative impact of reduced muscle mass and muscle function is increasingly evident across acute and chronic disease states but is particularly pronounced in patients with cancer. Ultrasound is emerging as a promising tool to directly measure skeletal muscle mass and quality. Unlike other ionizing imaging techniques, ultrasound can be used repeatedly at the bedside and may compliment nutritional risk assessment. This review aims to describe the current use of skeletal muscle ultrasound (SMUS) to measure muscle mass and quality in patients with acute and chronic clinical conditions and its ability to predict functional capacity, severity of malnutrition, hospital admission, and survival. Databases were searched from their inception to August 2021 for full-text articles in English. Relevant articles were included if SMUS was investigated in acute or chronic clinical contexts and correlated with a defined clinical outcome measure. Data were synthesized for narrative review due to heterogeneity between studies. This review analysed 37 studies (3100 patients), which met the inclusion criteria. Most studies (n = 22) were conducted in critical care. The clinical outcomes investigated included functional status at discharge (intensive care unit-acquired weakness), nutritional status, and length of stay. SMUS was also utilized in chronic conditions such as chronic obstructive pulmonary disease, chronic heart failure, and chronic renal failure to predict hospital readmission and disease severity. Only two studies investigated the use of SMUS in patients with cancer. Of the 37 studies, 28 (76%) found that SMUS (cross-sectional area, muscle thickness, and echointensity) showed significant associations with functional capacity, length of stay, readmission, and survival. There was significant heterogeneity in terms of ultrasound technique and outcome measurement across the included studies. This review highlights that SMUS continues to gain momentum as a potential tool for skeletal muscle assessment and predicting clinically important outcomes. Further work is required to standardize the technique in nutritionally vulnerable patients, such as those with cancer, before SMUS can be widely adopted as a bedside prognostic tool.
定量和监测去脂体重是营养评估的重要组成部分，可用于确定营养状况和肌肉损失。在急性和慢性疾病状态下，肌肉减少和肌肉功能下降的负面影响日益明显，但在癌症患者中尤为明显。超声作为一种直接测量骨骼肌质量和质量的有前途的工具正在出现。与其他电离成像技术不同，超声可以在床边重复使用，并可能补充营养风险评估。本综述旨在描述骨骼肌超声（SMUS）在急性和慢性临床情况下测量肌肉质量和质量的当前用途及其预测功能能力、营养不良严重程度、住院和生存的能力。从数据库成立到 2021 年 8 月，以英文全文文章的形式搜索数据库。如果 SMUS 在急性或慢性临床环境中进行了研究，并与定义明确的临床结果测量相关，则纳入相关文章。由于研究之间存在异质性，因此对数据进行了叙述性综述。本综述分析了 37 项研究（3100 名患者），这些研究符合纳入标准。大多数研究（n=22）在重症监护病房进行。研究中调查的临床结果包括出院时的功能状态（重症监护病房获得性肌无力）、营养状况和住院时间。SMUS 还用于慢性疾病，如慢性阻塞性肺疾病、慢性心力衰竭和慢性肾衰竭，以预测住院再入院和疾病严重程度。只有两项研究调查了 SMUS 在癌症患者中的应用。在 37 项研究中，有 28 项（76%）发现 SMUS（横截面积、肌肉厚度和超声强度）与功能能力、住院时间、再入院和生存有显著关联。纳入研究在超声技术和结果测量方面存在显著异质性。本综述强调，SMUS 作为一种评估骨骼肌和预测临床重要结果的潜在工具，其应用继续得到重视。在 SMUS 可以广泛用作床边预后工具之前，需要在营养脆弱的患者（如癌症患者）中进一步标准化该技术。
