Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
United European Gastroenterol J. 2024 Jun;12(5):562-573. doi: 10.1002/ueg2.12566. Epub 2024 Mar 28.
Sarcopenia is prevalent in patients with inflammatory bowel disease (IBD) and impacts surgical and therapeutic outcomes; thus, effective diagnostic tools are needed to assess muscle mass and function in this population.
153 consecutive patients were included, 100 in the training cohort and 53 in the study cohort. Three superficial muscles (rectus femoris = RF, rectus abdominis = RA, and biceps brachii = BB) were selected for the detection of sarcopenia using muscle ultrasound (US). The training cohort consisted of consecutive patients with or without IBD and was used to evaluate the feasibility and inter- and intra-observer variability of the US measurement. The study cohort consisted of only IBD patients and served to test US diagnostic accuracy. In the latter, muscle US, bioelectrical impedance analysis (BIA), and magnetic resonance imaging (MRI) were used to measure muscle parameters.
Sarcopenia prevalence in IBD patients was 50%. Muscle US showed excellent inter-rater and intra-rater reliability (ICC >0.95) and a good diagnostic accuracy in detecting sarcopenia compared to BIA with area under the receiver operating characteristic curve (AUROC) values of 80% and 85% for RA and BB thickness, respectively. Moreover, an Ultrasound Muscle Index (USMI) was defined as the sum of the RA, BB, and RF thickness divided by the square of the patient's height, resulting in an AUROC of 81%. Muscle thresholds for sarcopenia were detected, with RA and USMI values correlated with the highest positive (84.3%) and negative (99%) predictive values, respectively. Additionally, the agreement between the US and MRI measurements of RA was excellent (ICC 0.96).
The findings of this study emphasize the potential of muscle US as a reliable diagnostic tool for assessing sarcopenia in IBD patients. This research has significant implications for disease management in IBD patients and underscores the need for further investigations to validate these findings in larger cohorts.
肌肉减少症在炎症性肠病（IBD）患者中较为普遍，会影响手术和治疗效果，因此需要有效的诊断工具来评估该人群的肌肉质量和功能。
共纳入 153 例连续患者，其中 100 例纳入训练队列，53 例纳入研究队列。使用肌肉超声（US）检测 3 块表浅肌肉（股直肌=RF、腹直肌=RA 和肱二头肌=BB）是否存在肌肉减少症。训练队列由连续的 IBD 患者和非 IBD 患者组成，用于评估 US 测量的可行性和观察者内及观察者间的变异性。研究队列仅由 IBD 患者组成，用于测试 US 的诊断准确性。在后者中，使用肌肉 US、生物电阻抗分析（BIA）和磁共振成像（MRI）测量肌肉参数。
IBD 患者肌肉减少症的患病率为 50%。肌肉 US 显示出极好的观察者间和观察者内可靠性（ICC>0.95），与 BIA 相比，RA 和 BB 厚度的曲线下面积（AUROC）值分别为 80%和 85%，具有良好的诊断准确性。此外，定义超声肌肉指数（USMI）为 RA、BB 和 RF 厚度之和除以患者身高的平方，得到的 AUROC 为 81%。检测到肌肉减少症的肌肉阈值，RA 和 USMI 值与最高的阳性（84.3%）和阴性（99%）预测值相关。此外，US 和 MRI 测量 RA 的一致性非常好（ICC 0.96）。
本研究结果强调了肌肉 US 作为一种可靠的诊断工具，可用于评估 IBD 患者的肌肉减少症。这一研究结果对 IBD 患者的疾病管理具有重要意义，并强调需要进一步研究以在更大的队列中验证这些发现。
