Clinical value of ultrasound measurement of iliopsoas muscle cross-sectional area in the diagnosis of sarcopenia in elderly patients with type 2 diabetes mellitus
Objective To measure the iliopsoas muscle cross-sectional area(CSA)by ultrasound,and to explore the application value in diagnosing sarcopenia in elderly type 2 diabetes mellitus(T2DM)patients.Methods A total of 133 elderly patients with T2DM diagnosed in our hospital were selected,including sarcopenia group(38 cases)and non sarcopenia group(95 cases).The appendicular skeletal muscle mass(ASM)was measured by bioelectrical impedance analysis,and the handgrip strength(HGS)was measured by handheld dynamometer.The conventional ultrasound was used to measure the iliopsoas muscle CSA,and the DFY software was used to measure the average gray scale value and decibel value of the iliopsoas muscle.The differences of the general data and the CSA,average gray scale value and decibel value of the iliopsoas muscle between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between the iliopsoas muscle CSA and ASM,HGS.Multivariate Logistic regression analysis was used to screen the independent influencing factors of sarcopenia in elderly patients with T2DM,and a diagnostic model was constructed.Receiver operating characteristic(ROC)curve,calibration curve and clinical decision curve were drawn to evaluate the discrimination,calibration and clinical benefits of the model,respectively.Results The body mass index(BMI)and the iliopsoas muscle CSA in the sarcopenia group were lower than those in the non sarcopenia group,and the differences were statistically significant(all P<0.05).There were no significant difference in the average gray scale value and decibel value of iliopsoas between the two groups.The correlation analysis showed that the iliopsoas muscle CSA was positively correlated with ASM and HGS in all patients(r=0.55,0.53,both P<0.01).The iliopsoas muscle CSA in male patients was positively correlated with ASM and HGS(r=0.30,0.40,both P<0.05),whick was positively correlated with ASM and HGS in female patients(r=0.50,0.30,both P<0.01).Multivariate Logistic regression analysis showed that BMI and the iliopsoas muscle CSA were independent influencing factors of sarcopenia in elderly T2DM patients(OR=0.852,0.593,P=0.036,0.001),the diagnostic model was established as follow:Logit(P)=-0.160×BMI-0.522×iliopsoas muscle CSA+5.881.ROC curve analysis showed that the sensitivity,specificity and accuracy of the model for diagnosing sarcopenia in elderly T2DM patients were 62.4%,81.2%and 75.9%,respectively,and the area under the curve was 0.753.The calibration curve showed that the calibration degree between the actual probability and the predicted probability was good.The decision curve showed that according to the diagnostic model,the intervention of sarcopenia patients could obtain higher clinical benefits.Conclusion Ultrasound measurement of iliopsoas muscle CSA has high clinical application value in the diagnosis of elderly T2DM sarcopenia.
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