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| 床旁肌肉超声对胃肠道恶性肿瘤老年患者术前衰弱的诊断价值 |
| Diagnostic value of bedside muscular ultrasonography for preoperative frailty in elderly patients with gastrointestinal cancer |
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| DOI：10.12089/jca.2026.08.002 |
| 中文关键词: 股四头肌，股直肌 超声 老年 衰弱 诊断 |
| 英文关键词: Quadriceps muscle, rectus femoris Ultrasonography Aged Frailty Diagnosis |
| 基金项目:江苏省第六期“333高层次人才培养工程”；南京市卫生科技发展专项资金项目（YKK21064）；南京鼓楼医院临床研究专项资金项目（2024-LCYJ-PY-61） |
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| 中文摘要: |
目的： 探索床旁肌肉超声检查对胃肠道恶性肿瘤老年患者术前衰弱的诊断价值。
方法： 选择2023年8—10月行胃肠道肿瘤手术的老年患者，年龄≥65岁，BMI 18.5～28.0 kg/m2，ASA Ⅲ或Ⅳ级。术前采用衰弱表型（FP）评分对患者进行衰弱评估，根据FP评分将患者分为两组：衰弱组（FP评分≥3分）和非衰弱组（FP评分<3分）。麻醉诱导前行床旁肌肉超声，测量优势侧下肢股直肌横截面积、厚度和周长，术后记录Clavien-Dindo分级以评估患者早期预后。采用单因素和多因素Logistic回归模型分析股直肌横截面积、厚度、周长与FP评分诊断的衰弱的相关性，绘制受试者工作特征（ROC）曲线，并计算曲线下面积（AUC），评价床旁肌肉超声指标对衰弱的诊断价值。
结果： 共纳入患者84例，衰弱组15例，非衰弱组69例。多因素Logistic回归分析显示股直肌横截面积和股直肌厚度增加是FP评分诊断的衰弱的独立保护因素。ROC曲线显示，以FP评分作为衰弱诊断标准时，床旁超声股直肌横截面积、股直肌厚度以及二者联合对衰弱均有诊断价值，AUC分别为0.740（95%CI 0.604～0.875）、0.737（95%CI 0.590～0.885）和0.739（95%CI 0.604～0.874），股直肌横截面积、股直肌厚度和二者联合诊断衰弱的敏感性分别为1.000、0.600和1.000，特异性分别为0.391、0.783和0.391。
结论： 床旁超声测量股直肌横截面积及厚度对行胃肠道恶性肿瘤手术的老年患者术前衰弱有一定诊断价值。 |
| 英文摘要: |
Objective: To explore the diagnostic accuracy of bedside muscular ultrasonography in assessing preoperative frailty in elderly patients with gastrointestinal cancer.
Methods: This study enrolled elderly patients from August 2023 to October 2023, aged ≥ 65 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅲ or Ⅳ, who underwent gastric or colorectal cancer surgery. Frailty phenotype (FP) score was used to evaluate the frailty status of patients before surgery. Patients were divided into two groups based on the FP score: the frailty group (FP score ≥ 3 points) and the non-frailty group (FP score < 3 points). The cross-sectional area, thickness, and perimeter of rectus femoris muscle on the dominant side of the lower limb were measured by bedside muscle ultrasound before anesthesia induction. The patients were followed up after operation, and Clavien-Dindo grade were recorded to evaluate the surgery prognosis. Univariate analysis and multivariate logistic regression model were used to analyze the relationship between cross sectional area, thickness, circumference of rectus femoris muscle ultrasound index, and frailty diagnosed by FP score, and receiver operating characteristic (ROC) curve was draw to calculate the area under curve (AUC) to evaluate the diagnostic value of muscle ultrasound index.
Results: This study included 84 elderly patients, 15 patients in the frailty group and 69 patients in the non-frailty group. Multivariate logistic regression analysis showed that an increase in cross-sectional area and thickness of the rectus femoris muscle is an independent protective factor for frailty diagnosed by the FP score. ROC curve analysis showed that the cross-sectional area of rectus femoris, the thickness of rectus femoris, and the two indicators combined had diagnostic value for frailty when frailty phenotype was used as diagnostic criteria, with AUC of 0.740 (95% CI 0.604-0.875), 0.737 (95% CI 0.590-0.885), and 0.739 (95% CI 0.604-0.874), respectively. The sensitivity of cross-sectional area of rectus femoris, the thickness of rectus femoris, and the two indicators combined for diagnosing frailty was 1.000, 0.600, and 1.000, respectively. The specificity of cross-sectional area of rectus femoris, the thickness of rectus femoris, and the two indicators combined for diagnosing frailty was 0.391, 0.783, and 0.391, respectively.
Conclusion: The cross-sectional area and thickness of rectus femoris measured by bedside muscular ultrasonography have a certain diagnostic value for preoperative frailty in elderly patients undergoing gastric or colorectal cancer surgery. |
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