【目的 探讨肌骨超声在维持性血液透析患者肌少症评估中的应用价值。 方法 选取江苏省苏北人民医院血液净化中心维持性血液透析患者为研究对象，测量握力、骨骼肌质量指数等指标，使用肌骨超声测量腓肠肌厚度。按性别分为男性组和女性组。分析腓肠肌厚度与肌少症诊断指标之间的关系，使用ROC曲线分析腓肠肌厚度的最佳截断值。 结果 共纳入237例患者，其中男性147例，女性90例。腓肠肌厚度与维持性血液透析患者肌少症诊断指标存在相关性：腓肠肌厚度与握力和骨骼肌质量指数均呈正相关[总体(r=0.570、0.520，均P＜0.001)；男性组(r=0.631、0.535，均P＜0.001)；女性组(r=0.251、0.356，P=0.017、0.001)]。与非肌少症组相比，肌少症组患者的腓肠肌厚度减小[男性组(t=8.975,P＜0.001),女性组(t=4.725,P＜0.001)]。腓肠肌厚度预测不同性别维持性血液透析患者肌少症的ROC曲线显示：男性组AUC、最佳截断值、特异度、灵敏度分别为0.903、15.3、0.882、0.823；女性组AUC、最佳截断值、特异度、灵敏度分别为0.868、14.1、0.750、0.857。 结论 维持性血液透析患者的腓肠肌厚度与握力、骨骼肌质量指数呈正相关；男性腓肠肌厚度＜15.3 mm,女性＜14.1 mm时提示患者可能发生肌少症，临床医护人员可以将肌骨超声用于维持性血液透析患者肌少症的早期筛查，及早进行干预以提高患者生存质量。
Objective To investigate the application value of musculoskeletal ultrasound in the evaluation of sarcopenia in maintenance hemodialysis patients. Methods 237 patients with maintenance hemodialysis in the Blood Purification Center of Northern Jiangsu People’s Hospital were selected as the study objects. The grip strength and skeletal muscle index were measured, and the gastrocnemius muscle thickness was measured by ultrasound. Patents were into male and female group. The relationship between gastrocnemius thickness and diagnostic indicators of sarcopenia was analyzed, and the optimal cutoff value of gastrocnemius thickness was analyzed by the receiver operating characteristic (ROC) curves. Results The thickness of gastrocnemius was significantly correlated with sarcopenia in maintenance hemodialysis patients. The gastrocnemius muscle thickness was positively correlated with grip strength and skeletal muscle index in general, male and female groups，General (r=0.570, 0.520, P＜0.001); Male group (r=0.631, 0.535, P＜0.001); Female group (r=0.251, 0.356, P=0.017, 0.001). Compared with non-sarcopenia patients, the thickness of gastrocnemius in patients with sarcopenia was significantly reduced. Compared with the non-sarcopenia group, the gastrocnemius muscle thickness was reduced in the male group (t=8.975, P＜0.001) and the female group (t=4.725, P＜0.001). The ROC curves of subjects with sarcopenia predicted by gastrocnemius thickness in maintenance hemodialysis patients of different genders showed that: the area under the curve (AUC), optimal cut-off value, specificity and sensitivity of male group were 0.903, 15.3, 0.882 and 0.823, respectively. The area under the curve, optimal cut-off value, specificity and sensitivity of female suite were 0.868, 14.1, 0.750 and 0.857. Conclusion Gastrocnemius thickness was positively correlated with grip strength and skeletal muscle index in maintenance hemodialysis patients. If the thickness of gastrocnemius muscle is less than 15.3mm in males and less than 14.1mm in females, it indicates that patients may develop sarcopenia. Clinical staff can use musculoskeletal ultrasound for early screening of sarcopenia in maintenance hemodialysis patients, and make early intervention to improve the quality of life of patients.
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