medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-382medsovet-8579Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERСкелетно-мышечный индекс верхних конечностей для диагностики саркопении при циррозе печениUpper limb SMI for sarcopenia diagnosis in liver cirrhosishttps://orcid.org/0000-0002-9152-1279ОстровскаяА. С.OstrovskayaA. S.

Островская Анна Сергеевна, врач отделения гепатологии Клиники пропедевтики внутренних болезней, гастроэнтерологии, гепатологии им. В.Х. Василенко

119048, Москва, ул. Трубецкая, д. 8, стр. 2 

Anna S. Ostrovskaya, Physician, Department of Hepatology, Clinic of Propaedeutics of Internal Medicine, Gastroenterology, and Hepatology named after V.Kh. Vasilenko

8, Bldg. 2, Trubetskaya St., Moscow, 119991

ostrovskaya_a_s@staff.sechenov.ruhttps://orcid.org/0000-0001-8913-140XМаевскаяМ. В.MaevskayaM. V.

Маевская Марина Викторовна, д.м.н., профессор

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Marina V. Maevskaya, Dr. Sci. (Med.), Professor

8, Bldg. 2, Trubetskaya St., Moscow, 119991

liver.orc@mail.ruhttps://orcid.org/0000-0002-8333-2398ЛобанК. М.LobanK. M.

Лобан Константин Михайлович, к.м.н., старший научный сотрудник отдела абдоминальной хирургии Научно-исследовательского института клинической хирургии

117997, Москва, ул. Островитянова, д. 1

Konstantin M. Loban, Cand. Sci. (Med.), Senior Researcher, Department of Abdominal Surgery, Research Institute of Clinical Surgery

1, Ostrovityanov St., Moscow, 117997

loban_km@rsmu.ruhttps://orcid.org/0000-0001-5939-1032ЖарковаМ. С.ZharkovaM. S.

Жаркова Мария Сергеевна, к.м.н., заведующая отделением гепатологии Клиники пропедевтики внутренних болезней, гастроэнтерологии, гепатологии им. В.Х. Василенко

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Maria S. Zharkova, Cand. Sci. (Med.), Head of the Hepatology Department, Clinic of Propaedeutics of Internal Diseases, Gastroenterology, and Hepatology named after V.Kh. Vasilenko

8, Bldg. 2, Trubetskaya St., Moscow, 119991

zharkova_maria_s@staff.sechenov.ruШапкаМ. П.ShapkaM. P.

Шапка Маргарита Петровна, врач-рентгенолог отделения лучевой диагностики клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Margarita P. Shapka, Radiologist, Department of Radiation Diagnostics, Clinic of Propaedeutics of Internal Medicine, Gastroenterology and Hepatology named after V.Kh. Vasilenko

8, Bldg. 2, Trubetskaya St., Moscow, 119991

shapka_m_p@staff.sechenov.ruhttps://orcid.org/0000-0002-1210-2528НадинскаяМ. Ю.NadinskaiaM. Yu.

Надинская Мария Юрьевна, к.м.н., доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Maria Yu. Nadinskaia, Cand. Sci. (Med.), Associate Professor, Department of Propaedeutics of Internal Diseases

8, Bldg. 2, Trubetskaya St., Moscow, 119991

nadinskaya_m_yu@staff.sechenov.ruhttps://orcid.org/0000-0002-3462-0123ГуляеваК. А.GulyaevaK. A.

Гуляева Ксения Александровна, аспирант кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Kseniya A. Gulyaeva, Postgraduate Student, Department of Propaedeutics of Internal Diseases

8, Bldg. 2, Trubetskaya St., Moscow, 119991

xen59@mail.ruhttps://orcid.org/0009-0007-5170-5464ВасильцоваЕ. А.VasiltsovaE. A.

Васильцова Екатерина Андреевна, студент

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Ekaterina A. Vasiltsova, Student

8, Bldg. 2, Trubetskaya St., Moscow, 119991

vasiltsova.c@yandex.ruhttps://orcid.org/0009-0004-0897-4552ЧвилеваЮ. О.ChvilevaYu. O.

Чвилева Юлия Олеговна, студент

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Yulia O. Chvileva, Student

8, Bldg. 2, Trubetskaya St., Moscow, 119991

chvileva.yulya@mail.ruhttps://orcid.org/0000-0002-6815-6015ИвашкинВ. Т.IvashkinV. T.

Ивашкин Владимир Трофимович, акад. РАН, д.м.н., профессор, заведующий кафедрой пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

119048, Москва, ул. Трубецкая, д. 8, стр. 2

Vladimir T. Ivashkin, Acad. of the RAS, Dr. Sci. (Med.), Professor, Head of the Department of Propaedeutics of Internal Diseases, Gastroenterology, and Hepatology

8, Bldg. 2, Trubetskaya St., Moscow, 119991

ivashkin_v_t@staff.sechenov.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationРоссийский национальный исследовательский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202416102024015126–134Copyright © Островская А.С., Маевская М.В., Лобан К.М., Жаркова М.С., Шапка М.П., Надинская М.Ю., Гуляева К.А., Васильцова Е.А., Чвилева Ю.О., Ивашкин В.Т., 20242024Островская А.С., Маевская М.В., Лобан К.М., Жаркова М.С., Шапка М.П., Надинская М.Ю., Гуляева К.А., Васильцова Е.А., Чвилева Ю.О., Ивашкин В.Т.Ostrovskaya A.S., Maevskaya M.V., Loban K.M., Zharkova M.S., Shapka M.P., Nadinskaia M.Y., Gulyaeva K.A., Vasiltsova E.A., Chvileva Y.O., Ivashkin V.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8579Введение

Введение. Для оценки мышечной массы при саркопении у пациентов с циррозом печени (ЦП) используются скелетно-мышечные индексы (СМИ), определяемые методом двухэнергетической рентгеновской абсорбциометрии (ДРА), результаты которых искажаются за счет отеков нижних конечностей. Это требует разработки СМИ для верхних конечностей (СМИ ВК) с целью более точной оценки мышечной массы у пациентов с ЦП и отечно-асцитическим синдромом.

Цель

Цель. Сравнить диагностическую точность стандартного СМИ и СМИ ВК, разработать критерии нормы СМИ ВК для пациентов с декомпенсированным ЦП различной этиологии и саркопенией с учетом отеков нижних конечностей в сопоставимых возрастных группах.

Материалы и методы

Материалы и методы. Проведено проспективное когортное исследование. Основная группа – пациенты с декомпенсированным ЦП и отеками нижних конечностей различной этиологии; контрольная группа – здоровые добровольцы, сопоставимые по полу и возрасту для определения диагностической точности метода и расчета критериев нормы для СМИ ВК. Всем пациентам выполнялась оценка мышечной массы с применением ДРА.

Результаты

Результаты. Исследовано 59 пациентов: 39 с ЦП и 20 здоровых добровольцев. Пороговое значение (cutoff) по результатам ROC-анализа для СМИ ВК для мужчин – 1,91 кг/м2 (чувствительность 62,5%, специфичность 85,71%) и для женщин – 1,47 кг/м2 (чувствительность 86,96%, специфичность 69,23%) по сравнению с пороговым значением стандартного СМИ мужчин – 7,78 кг/м2 (чувствительность 75% и специфичность 57,14%), СМИ женщин – 6,05 кг/м2 (чувствительность 56,52% и специфичность 69,23%). СМИ ВК – более точный маркер саркопении для пациентов с ЦП и отеками нижних конечностей, чем стандартный СМИ.

Выводы

Выводы. Продемонстрированы преимущества показателя СМИ ВК перед классическим СМИ для диагностики саркопении у пациентов с ЦП и отеками нижних конечностей. Разработаны критерии нормы для пациентов с декомпенсированным ЦП и саркопенией для СМИ ВК.

Introduction

Introduction. The muscle mass in sarcopenia is assessed in patients with liver cirrhosis (LC) using skeletal muscle indices (SMI) measured by dual-energy X-ray absorptiometry (DXA), the results of which are distorted due to lower limb edema. This requires the development of upper limb SMI (UL SMI) to ensure more accurate assessment of muscle mass in patients with LC and ascitice-dematous syndrome.

Aim

Aim. To compare the diagnostic accuracy of standard MSI and UL SMI, and develop criteria for the reference range of UL SMI in patients with decompensated LC of various origin and sarcopenia, taking into account the lower limb edema in comparable age groups.

Materials and methods

Materials and methods. A prospective cohort study was conducted. The treatment group included patients with decompensated LC and lower limb edema of various origin; the control group included healthy volunteers matched to patients by gender and age to determine the diagnostic accuracy of the technique and calculate the criteria for the reference ranges in UP SMI. All patients underwent measurements of muscle mass by DXA.

Results

Results. A total of 59 patients were examined: 39 patients with LC and 20 healthy volunteers. Based on the results of the ROC analysis, it was determined that the cut-off values for UL SMI are 1.91 kg/m2 for men (sensitivity = 62.5%, specificity = 85.71%) and 1.47 kg/m2 for women (sensitivity = 86.96%, specificity = 69.23%) as compared to the cut-off values for the standard SMI of 7.78 kg/m2 for men (sensitivity = 75% and specificity = 57.14%), and SMI of 6.05 kg/m2 for women (sensitivity = 56.52% and specificity = 69.23%). UL SMI is a more accurate marker of sarcopenia in patients with LC and lower limb edema than the standard SMI.

Conclusion

Conclusion. The advantages of UL SMI over classical SMI for sarcopenia diagnosis in patients with cirrhosis and lower extremity edema were demonstrated. The UL SMI criteria for the reference range in patients with decompensated LC and sarcopenia were developed.

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The authors declare that there are no conflicts of interest present.