Revista clinica espanola最新文献

英文中文

Prevalencia y características de la anemia en personas con diabetes mellitus de 50 años o más en un área sanitaria de Cádiz (España) 加的斯（西班牙）一个健康地区 50 岁及以上糖尿病患者贫血症的患病率和特征。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.007

Background

Anemia is a common comorbidity in patients with diabetes mellitus (DM), particularly in older adults. However, there is a lack of data on the prevalence and the characteristics of anemia in this population in Spain.

Objective

To describe the prevalence and the characteristics of anemia in patients with DM aged 50 or older (PDM50) in a healthcare district in the province of Cádiz.

Methods

A retrospective cross-sectional study was conducted that included outpatient's laboratory tests (OLT) performed over 30 months at PDM50.

Results

The prevalence of anemia was 29.9% (95% CI: 28.7-31.1%), predominating in women (33.3% vs 26.7%; p< 0.01), in older people stratified by decades (61.7% in 9 th decade vs 12% in 5 th decade; p< 0.01), and in those with kidney disease (44.7% vs 28%; p< 0.01). Most cases were mild (68.3%), normocytic (78.7%), and hypochromic (52%). Similarly, moderate-to-severe anemia was more frequent in women (39% vs 23%), their prevalence increased with age (45% in the 9 th decade vs 24% in the 5 th decade), and with the progression of kidney damage, either measured by a decreased glomerular filtration rate (GFR) (49% in G4 vs 25% in G1), or the presence of albuminuria (p < 0.01). No association was found between DM control, based on glycated hemoglobin (HbA1c), and anemia in either sex (p = 0.887).

Conclusion

This study describes a high prevalence of anemia in PDM50, particularly in women, in the most advantageous people and in the presence of kidney disease, even in early stages, highlighting the clinical importance of this coexistence.

背景贫血是糖尿病（DM）患者，尤其是老年人常见的合并症。目的描述加的斯省一个医疗区 50 岁或以上 DM 患者（PDM50）的贫血患病率和特征。结果贫血患病率为 29.9% (95% CI: 28.7-31. 1%) ，以女性为主。1%），女性居多（33.3% 对 26.7%；p<；0.01），按年代分，老年人居多（61.7% 在第 9 个年代，12% 在第 5 个年代；p<；0.01），肾病患者居多（44.7% 对 28%；p<；0.01）。大多数病例为轻度（68.3%）、正常红细胞（78.7%）和低色素（52%）。同样，中重度贫血在女性中更为常见（39% 对 23%），其发病率随着年龄的增长而增加（45% 发生在第 9 个 10 年，24% 发生在第 5 个 10 年），并随着肾脏损害的进展而增加，肾脏损害是指肾小球滤过率（GFR）的下降（49% 发生在 G4，25% 发生在 G1）或白蛋白尿的出现（p< 0.01）。结论：本研究描述了 PDM50 中贫血的高发率，尤其是在女性、优势人群和存在肾脏疾病（即使是早期阶段）的人群中，强调了这种并存现象的临床重要性。

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引用次数: 0

Bronquiectasias, adenopatías relacionadas con la sobreexpresión del factor activador de los linfocitos B perteneciente a la familia del factor de necrosis tumoral y cistitis linfoplasmocítica como eventos adversos asociados al uso prolongado de rituximab en enfermedades reumáticas autoinmunes sistémicas 支气管扩张、与肿瘤坏死因子家族的 B 淋巴细胞活化因子（B 淋巴细胞活化因子）过度表达有关的腺病以及淋巴细胞性膀胱炎是全身性自身免疫性风湿病患者长期使用利妥昔单抗引起的不良反应。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.04.015

Background

The long-term use of rituximab (RTX) has been gaining ground in the treatment of systemic autoimmune diseases. The adverse events (AEs) associated with its use different to infections are being reported.

Methods

A cohort of patients with SAIDs treated at a high-complexity center in Cali (southwestern Colombia) with follow-up from January 2008 to December 2022 were examined to search for potential AEs associated with prolonged use of RTX.

Results

From 178 patients with long-term use of RTX 3 (1.68%) had lymphadenopathies with lymphoid follicular hyperplasia related to BAFF overexpression, 4 (2.24%) with bronchiectasis, and 4 (2.24%) with lymphoplasmacytic cystitis.

Conclusion

Bronchiectasis, lymphoid follicular hyperplasia related to BAFF overexpression, and lymphoplasmacytic cystitis may be life-threatening long-term AEs in patients with prolonged use of RTX.

背景长期使用利妥昔单抗（RTX）治疗全身性自身免疫性疾病的趋势日益明显。方法对2008年1月至2022年12月期间在卡利（哥伦比亚西南部）一家高复杂性中心接受治疗的SAIDs患者进行队列研究，以寻找与长期使用RTX相关的潜在AEs。结论支气管扩张、与 BAFF 过度表达相关的淋巴滤泡增生和淋巴浆细胞性膀胱炎可能是长期使用 RTX 患者中危及生命的长期 AE。

引用次数: 0

Espectro etiológico y desafíos diagnósticos de la fiebre de corta duración en Bengala Occidental (India): un estudio transversal en un centro de atención terciaria 印度西孟加拉邦短程发热的病原谱和诊断难题：在一家三级医疗中心进行的横断面研究。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.06.002

Introduction

The scarcity of epidemiological data on acute febrile illnesses from South Asia impairs evidence-based clinical decision-making. Our study aimed to explore the etiological spectrum of short-duration fever in patients admitted to a tertiary care hospital in West Bengal, India.

Methods

We conducted a cross-sectional study from May 2021 to April 2022 involving 150 adult patients presenting with a fever lasting less than two weeks at Burdwan Medical College and Hospital (West Bengal, India). We performed comprehensive clinical assessments, including microbiological, serological, and other specific investigations, to identify the causes of the fever.

Results

The demographic profile predominantly included individuals aged 21-40 years, with a male-to-female ratio of 1.9:1; 60.7% of participants were from rural areas. The primary etiological agents identified were scrub typhus (25.3%), dengue (15.3%), and enteric fever (13.3%). Notably, 80% of patients presented with non-localizing symptoms, while 14.7% had respiratory symptoms. Blood cultures pinpointed Salmonella typhi and Staphylococcus aureus in a minority of cases (3.3%); malaria, primarily Plasmodium vivax, was diagnosed in 12% of the cases.

Conclusion

Our findings highlight the complexity of diagnosing short-duration fevers, dominated by a wide range of etiological agents, with a notable prevalence of scrub typhus. These results underscore the urgent need for enhanced diagnostic facilities, including the availability of scrub typhus testing at primary healthcare centers. We recommend empirical doxycycline therapy for suspected cases and emphasize the need for further research to develop management guidelines for acute febrile illnesses. This study also highlights the importance of raising both community and clinician awareness to prevent irrational antibiotic use.

导言南亚地区急性发热疾病的流行病学数据稀缺，影响了以证据为基础的临床决策。我们在 2021 年 5 月至 2022 年 4 月期间进行了一项横断面研究，涉及 150 名在 Burdwan 医学院和医院（印度西孟加拉邦）就诊的发热持续时间少于两周的成年患者。我们进行了全面的临床评估，包括微生物学、血清学和其他特殊检查，以确定发烧的原因。结果人口统计学特征主要包括 21-40 岁的人，男女比例为 1.9:1；60.7% 的参与者来自农村地区。主要病原体为恙虫病（25.3%）、登革热（15.3%）和肠热（13.3%）。值得注意的是，80%的患者出现非局部症状，14.7%的患者出现呼吸道症状。少数病例（3.3%）的血液培养结果为伤寒沙门氏菌和金黄色葡萄球菌；12%的病例被诊断为疟疾，主要是间日疟原虫。这些结果突出表明，迫切需要加强诊断设施，包括在初级医疗保健中心提供恙虫病检测。我们建议对疑似病例进行经验性强力霉素治疗，并强调有必要开展进一步研究，以制定急性发热性疾病的管理指南。这项研究还强调了提高社区和临床医生对防止不合理使用抗生素的认识的重要性。

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引用次数: 0

Carta réplica a «Prevalencia de anticuerpos neutralizantes frente al SARS-CoV-2 inducidos tras 2 dosis de vacuna BNT162b2 (Pfizer–BioNTech) en trabajadores sanitarios» 对 "医护人员接种两剂 BNT162b2 疫苗（辉瑞-生物技术公司）后产生的 SARS-CoV-2 中和抗体的流行率 "的答复

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.006

引用次数: 0

Respuesta a la carta al Director sobre «Prevalencia de anticuerpos neutralizantes frente al SARS-CoV-2 inducidos tras 2 dosis de vacuna BNT162b2 (Pfizer–BioNTech) en trabajadores sanitarios» 对 "医护人员接种两剂 BNT162b2 疫苗（辉瑞-生物技术公司）后产生的 SARS-CoV-2 中和抗体的流行情况 "的致编辑信的回复。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.06.001

引用次数: 0

Utilidad del 18F-FDG-PET/TC en la detección de vasculitis de gran vaso extracraneal en pacientes con polimialgia reumática o arteritis de células gigantes: revisión sistemática y metaanálisis 18F-FDG-PET/CT在检测多发性风湿痛或巨细胞动脉炎患者颅外大血管炎中的作用：系统综述和荟萃分析。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.04.016

Objective

Systematic review of current evidence to analyze the prevalence of extracranial large vessel vasculitis (LVV) using ¹⁸F-FDG PET/CT in patients with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA).

Materials and methods

PubMed and EMBASE were searched and the results were screened by two reviewers. Study quality was assessed using a modified version of the Newcastle-Ottawa scale. Heterogeneity between studies was assessed using the I² statistic and the Q test. Further subgroup analyses were performed by disease type, study quality, and ¹⁸F-FDG PET/CT uptake criteria. Publication bias was assessed by funnel plot and Egger's test.

Results

268 publications were identified, of which 17 met the selection criteria and were included in the meta-analysis. The overall pooled prevalence of extracranial VGV by ¹⁸F-FDG PET/CT was 54.5% [95% CI: 42.6% to 66.1%]. In patients with GCA the prevalence was significantly higher than in patients with PMR (60.1% vs. 41.8%, P= .006). Likewise, studies with a lower risk of bias reported a higher prevalence of extracranial VGV (61.1% vs. 46.9%; P= .010). No publication bias was observed.

Conclusions

The ¹⁸F-FDGPET/CT test may be useful in the detection of extracranial VGV, both in patients with PMR or GCA. Such involvement is more frequent in patients with GCA, and may vary depending on the quality of the studies.

目的系统回顾目前的证据，利用 18F-FDG PET/CT 分析多发性风湿痛（PMR）或巨细胞动脉炎（GCA）患者颅外大血管炎（LVV）的患病率。研究质量采用修订版纽卡斯尔-渥太华量表进行评估。研究之间的异质性采用 I2 统计量和 Q 检验进行评估。根据疾病类型、研究质量和 18F-FDG PET/CT 摄取标准进行了进一步的亚组分析。通过漏斗图和 Egger 检验对发表偏倚进行了评估。结果共发现 268 篇文献，其中 17 篇符合筛选标准，被纳入荟萃分析。通过18F-FDG PET/CT汇总的颅外VGV总患病率为54.5%[95% CI：42.6%至66.1%]。GCA患者的患病率明显高于PMR患者（60.1%对41.8%，P= .006）。同样，偏倚风险较低的研究报告了较高的颅外VGV患病率（61.1% vs. 46.9%；P= .010）。结论18F-FDGPET/CT检查可用于检测颅外VGV，无论是PMR患者还是GCA患者。这种累及在 GCA 患者中更为常见，而且可能因研究质量而异。

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引用次数: 0

E-consulta entre Atención Primaria y Medicina Interna: implementación, accesibilidad, beneficios e implicaciones 初级保健和内科之间的电子会诊：实施、可及性、益处和影响

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.003

Aim

This work aims to evaluate whether electronic consultations (e-consults) are a clinically useful, safe tool for assessing patients between primary care and internal medicine.

Methods

This is a retrospective cohort study of all e-consults ordered by the Primary Care Department to the Internal Medicine Department between September 2019 and December 2023. The results of initial consultations, emergency department visits and subsequent admissions, and survival were assessed and complaints and claims filed were reviewed.

Results

A total of 11,434 e-consults were recorded (55.4% women) with a mean age of 62.1 (SD19.4) years and a wide range (15 to 102 years). The mean response time was 2.55 (SD 1.6) days. As a result of the e-consults, 5,645 patients (49.4%) were given an in-person appointment. For the remaining 5,789 (50.6%), a written response was provided. Among those given appointments, the time between the response and in-person appointment was less than five days (95% of cases). Compared to those not given appointments, in-person appointments were older (p < 0.0001), visited the emergency department more times (one month: p = 0.04; three months: p = 0.001), were admitted to the hospital more times (one month: p = 0.0001; three months: p = 0.0001), and had higher mortality at one year (12.7% vs. 9.8% p = 0.0001). On the Cox analysis, only in-person appointments (RR = 1.11; p = 0.04) and age (RR = 1.09; p < 0.01) were independent factors of mortality. No complaints or claims of any kind were registered.

Conclusions

These data suggest that e-consults are a clinically useful, safe tool for assessing patients referred from primary care to internal medicine departments.

目的这项工作旨在评估电子会诊（e-consults）是否是在初级保健和内科之间评估患者的一种临床有用、安全的工具。方法这是一项回顾性队列研究，研究对象是2019年9月至2023年12月期间初级保健科向内科下达的所有电子会诊。结果共记录了 11,434 次电子会诊（55.4% 为女性），平均年龄为 62.1 岁（SD19.4），年龄跨度较大（15 至 102 岁）。平均回复时间为 2.55 天（标准差 1.6 天）。通过电子会诊，5,645 名患者（49.4%）获得了面诊预约。其余 5789 名患者（50.6%）获得了书面回复。在获得预约的患者中，从回复到面诊之间的时间不到五天（95% 的病例）。与未获得预约的患者相比，亲自预约的患者年龄更大（p <0.0001），去急诊科就诊的次数更多（一个月：p = 0.04；三个月：p = 0.001），入院治疗的次数更多（一个月：p = 0.0001；三个月：p = 0.0001），一年后的死亡率更高（12.7% 对 9.8% p = 0.0001）。在 Cox 分析中，只有亲自预约（RR = 1.11；P = 0.04）和年龄（RR = 1.09；P < 0.01）是影响死亡率的独立因素。结论这些数据表明，电子会诊是一种临床实用、安全的工具，可用于评估从初级保健转诊到内科的患者。

{"title":"E-consulta entre Atención Primaria y Medicina Interna: implementación, accesibilidad, beneficios e implicaciones","authors":"","doi":"10.1016/j.rce.2024.05.003","DOIUrl":"10.1016/j.rce.2024.05.003","url":null,"abstract":"<div><h3>Aim</h3><p>This work aims to evaluate whether electronic consultations (e-consults) are a clinically useful, safe tool for assessing patients between primary care and internal medicine.</p></div><div><h3>Methods</h3><p>This is a retrospective cohort study of all e-consults ordered by the Primary Care Department to the Internal Medicine Department between September 2019 and December 2023. The results of initial consultations, emergency department visits and subsequent admissions, and survival were assessed and complaints and claims filed were reviewed.</p></div><div><h3>Results</h3><p>A total of 11,434 e-consults were recorded (55.4% women) with a mean age of 62.1 (SD19.4) years and a wide range (15 to 102 years). The mean response time was 2.55 (SD 1.6) days. As a result of the e-consults, 5,645 patients (49.4%) were given an in-person appointment. For the remaining 5,789 (50.6%), a written response was provided. Among those given appointments, the time between the response and in-person appointment was less than five days (95% of cases). Compared to those not given appointments, in-person appointments were older (<em>p</em>  =0.04; three months: <em>p</em>  =0.0001; three months: <em>p</em>  =0.0001). On the Cox analysis, only in-person appointments (RR=1.11; <em>p</em>    <0.01) were independent factors of mortality. No complaints or claims of any kind were registered.</p></div><div><h3>Conclusions</h3><p>These data suggest that e-consults are a clinically useful, safe tool for assessing patients referred from primary care to internal medicine departments.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tratamiento anticoagulante oral en la fibrilación auricular: AFIRMA, el estudio de vida real realizado mediante procesamiento de lenguaje natural y aprendizaje automático 心房颤动的口服抗凝疗法：AFFIRM，利用自然语言处理和机器学习进行的真实生活研究

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.005

Introduction

Oral anticoagulation (OAC) is key in atrial fibrillation (AF) thromboprophylaxis, but Spain lacks substantial real-world evidence. We aimed to analyze the prevalence, clinical characteristics, and treatment patterns among patients with AF undertaking OAC, using natural language processing (NLP) and machine learning (ML).

Materials and methods

This retrospective study included AF patients on OAC from 15 Spanish hospitals (2014-2020). Using EHRead® (including NLP and ML), and SNOMED_CT, we extracted and analyzed patient demographics, comorbidities, and OAC treatment from electronic health records. AF prevalence was estimated, and a descriptive analysis was conducted.

Results

Among 4,664,224 patients in our cohort, AF prevalence ranged from 1.9% to 2.9%. A total of 57,190 patients on OAC therapy were included, 80.7% receiving Vitamin K antagonists (VKA) and 19.3% Direct-acting OAC (DOAC). The median age was 78 and 76 years respectively, with males constituting 53% of the cohort. Comorbidities like hypertension (76.3%), diabetes (48.0%), heart failure (42.2%), and renal disease (18.7%) were common, and more frequent in VKA users. Over 50% had a high CHA₂DS₂-VASc score. The most frequent treatment switch was from DOAC to acenocoumarol (58.6% to 70.2%). In switches from VKA to DOAC, apixaban was the most chosen (35.2%).

Conclusions

Utilizing NLP and ML to extract RWD, we established the most comprehensive Spanish cohort of AF patients with OAC to date. Analysis revealed a high AF prevalence, patient complexity, and a marked VKA preference over DOAC. Importantly, in VKA to DOAC transitions, apixaban was the favored option.

导言口服抗凝药（OAC）是心房颤动（AF）血栓预防的关键，但西班牙缺乏大量的实际证据。我们旨在利用自然语言处理（NLP）和机器学习（ML）分析接受 OAC 的房颤患者的患病率、临床特征和治疗模式。我们使用 EHRead®（包括 NLP 和 ML）和 SNOMED_CT，从电子健康记录中提取并分析了患者的人口统计学特征、合并症和 OAC 治疗。结果在我们队列中的 4,664,224 名患者中，房颤患病率介于 1.9% 到 2.9% 之间。共纳入了 57190 名接受 OAC 治疗的患者，其中 80.7% 接受维生素 K 拮抗剂 (VKA)，19.3% 接受直接作用 OAC (DOAC)。中位年龄分别为 78 岁和 76 岁，男性占 53%。高血压（76.3%）、糖尿病（48.0%）、心力衰竭（42.2%）和肾病（18.7%）等并发症很常见，在 VKA 使用者中更为常见。超过 50% 的患者 CHA2DS2-VASc 评分较高。最常见的治疗转换是从 DOAC 到醋硝香豆素（58.6% 到 70.2%）。结论利用 NLP 和 ML 提取 RWD，我们建立了迄今为止最全面的使用 OAC 的房颤患者西班牙队列。分析表明，房颤患病率高、患者病情复杂，且患者明显偏好 VKA 而非 DOAC。重要的是，在 VKA 向 DOAC 过渡时，阿哌沙班是首选。

{"title":"Tratamiento anticoagulante oral en la fibrilación auricular: AFIRMA, el estudio de vida real realizado mediante procesamiento de lenguaje natural y aprendizaje automático","authors":"","doi":"10.1016/j.rce.2024.05.005","DOIUrl":"10.1016/j.rce.2024.05.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Oral anticoagulation (OAC) is key in atrial fibrillation (AF) thromboprophylaxis, but Spain lacks substantial real-world evidence. We aimed to analyze the prevalence, clinical characteristics, and treatment patterns among patients with AF undertaking OAC, using natural language processing (NLP) and machine learning (ML).</p></div><div><h3>Materials and methods</h3><p>This retrospective study included AF patients on OAC from 15 Spanish hospitals (2014-2020). Using EHRead® (including NLP and ML), and SNOMED_CT, we extracted and analyzed patient demographics, comorbidities, and OAC treatment from electronic health records. AF prevalence was estimated, and a descriptive analysis was conducted.</p></div><div><h3>Results</h3><p>Among 4,664,224 patients in our cohort, AF prevalence ranged from 1.9% to 2.9%. A total of 57,190 patients on OAC therapy were included, 80.7% receiving Vitamin K antagonists (VKA) and 19.3% Direct-acting OAC (DOAC). The median age was 78 and 76 years respectively, with males constituting 53% of the cohort. Comorbidities like hypertension (76.3%), diabetes (48.0%), heart failure (42.2%), and renal disease (18.7%) were common, and more frequent in VKA users. Over 50% had a high CHA<sub>2</sub>DS<sub>2</sub>-VASc score. The most frequent treatment switch was from DOAC to acenocoumarol (58.6% to 70.2%). In switches from VKA to DOAC, apixaban was the most chosen (35.2%).</p></div><div><h3>Conclusions</h3><p>Utilizing NLP and ML to extract RWD, we established the most comprehensive Spanish cohort of AF patients with OAC to date. Analysis revealed a high AF prevalence, patient complexity, and a marked VKA preference over DOAC. Importantly, in VKA to DOAC transitions, apixaban was the favored option.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Valor de la ecografía multimodal en la evaluación de la sarcopenia en pacientes en hemodiálisis de mantenimiento 多模态超声波在评估维持性血液透析患者肌少症中的价值。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.004

Introduction

Sarcopenia is one of the common complications in maintenance hemodialysis (MHD) patients and is associated with poor prognosis. We aimed to study the validity and reliability of ultrasound in the assessment of sarcopenia in MHD patients.

Methods

MHD patients were categorized into the sarcopenia group and the non-sarcopenia group according to the diagnostic criteria of the Asian Working Group on Sarcopenia (AWGS) 2019. Ultrasonography of the left medial head of the gastrocnemius muscle was performed in MHD and healthy controls to obtain muscle thickness (MT), pinnation angle (PA), fascicle length (FL), cross-sectional area (CSA), echo intensity (EI), elastic modulus (E), shear wave velocity (SWV), and microvascular velocity (MV). Compare the differences in ultrasound parameters among different groups, and determine the cut-off values suitable for diagnosing sarcopenia in MHD patients.

Results

The MT, CSA, PA, and MV in the sarcopenia group were lower than those in the non-sarcopenia group and the control group; while the EI was higher, the FL of the sarcopenia group was lower than that of the non-sarcopenia group, while the E and SWV of the sarcopenia group were higher than those of the control group. Receiver operating characteristic curve analyses indicated that ultrasound combined index had a good diagnostic value, model Y = 13.511 - 0.121 * MT - 0.609 * CSA - 0.172 * PA + 0.011 * EI - 2.205 * MV (p < 0.05), with a cut-off value of 0.69.

Conclusions

Multi-modal ultrasound is a safe, non-invasive, and real-time imaging examination method, and can provide information on muscle structure, stiffness, and perfusion, which is expected to be a promising potential tool for predicting sarcopenia in MHD patients.

引言肌肉疏松症是维持性血液透析（MHD）患者常见的并发症之一，与预后不良有关。我们旨在研究超声波在评估血液透析患者肌肉疏松症中的有效性和可靠性。方法根据亚洲肌肉疏松症工作组（AWGS）2019 年的诊断标准，将血液透析患者分为肌肉疏松症组和非肌肉疏松症组。对MHD患者和健康对照组的腓肠肌左内侧头进行超声检查，以获得肌肉厚度（MT）、羽状角（PA）、筋膜长度（FL）、横截面积（CSA）、回声强度（EI）、弹性模量（E）、剪切波速度（SWV）和微血管速度（MV）。结果肌肉疏松症组的 MT、CSA、PA 和 MV 均低于非肌肉疏松症组和对照组；而 EI 较高，肌肉疏松症组的 FL 低于非肌肉疏松症组，肌肉疏松症组的 E 和 SWV 则高于对照组。接收器操作特征曲线分析表明，超声综合指数具有良好的诊断价值，模型 Y = 13.511 - 0.121 * MT - 0.609 * CSA - 0.172 * PA + 0.011 * EI - 2.205 * MV (p < 0.05)，临界值为 0.69。结论多模态超声是一种安全、无创、实时的成像检查方法，可提供肌肉结构、僵硬度和灌注信息，有望成为预测 MHD 患者肌肉疏松症的潜在工具。

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引用次数: 0

El internista joven a la vanguardia de la investigación clínica 走在临床研究前沿的年轻内科医生

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2024-08-01 DOI: 10.1016/j.rce.2024.05.002

引用次数: 0

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