肌肉超声回声联合血浆炎性因子对ICUAW诊断及预后评估的价值研究

Diagnostic and prognostic value of muscle echogenicity combined with plasma inflammatory factors for intensive care unit-acquired weakness

摘要

目的 探讨重症监护病房（intensive care unit，ICU）获得性肌无力（ICU acquired weakness，ICUAW）患者肌肉超声回声与血浆炎性因子的相关性，以及其对ICUAW的诊断价值和预后的预测价值。 方法 选择重庆市急救医疗中心ICU住院患者，分别在第1、3、7天使用床旁超声检测患者肌肉回声，获得的总体肌肉回声评分（global muscle echogenicity score，GEM），测定血清白细胞介素-6（interleukin-6，IL-6）和降钙素原（procalcitonin，PCT）浓度，采用医学研究理事会肌力评分法（medical research council scales，MRC-ss）评估肌肉力量。根据患者入ICU第7天MRC-ss评分将患者分为ICUAW组和非ICUAW组，分析比较2组患者GEM、IL-6、PCT的差异及各指标的相关性。利用受试者工作特征（receiver operator characteristic，ROC）曲线分析以上参数对ICUAW诊断效能，分析GEM、IL-6、PCT对ICUAW患者的预测预后价值。 结果 ICUAW组第3天GEM、第7天IL-6浓度、GEM高于非ICUAW组（P<0.05）。GEM与第7天IL-6水平呈正相关（r=0.221），第7天GEM与MRC-ss评分呈负相关（r=-0.581）。ROC曲线分析显示，第7天GEM对ICUAW有诊断预测价值，ROC曲线下面积（area under the curve，AUC）为0.838，使用GEM、IL-6、PCT联合诊断，AUC=0.885（P<0.05）。ICUAW组Barthel指数评分（Barthel index，BI）低于非ICUAW组，ICUAW组中总体肌肉超声回声评分（global muscle echogenicity score，GEM）高的患者BI低于GEM低的患者（P<0.05）。 结论 ICU住院患者GEM与IL-6、PCT浓度相关，其对ICUAW具有一定的诊断价值，并能够预测ICUAW患者的预后。

Abstract

Objective To investigate the correlation between muscle echogenicity and plasma inflammatory factors in patients with intensive care unit-acquired weakness（ICUAW） and its diagnostic and prognostic value for ICUAW. Methods Patients hospitalized in the intensive care unit（ICU） in Chongging Emergency Medical Center were included. Their muscle echogenicity was measured using bedside ultrasonography on the 1st，3rd，and 7th day，and the global muscle echogenicity（GME） score was assessed. Serum interleukin-6（IL-6） and procalcitonin（PCT） levels were measured. Muscle strength was scored using the Medical Research Council Scale for Muscle Strength（MRC-ss）. The patients were divided into ICUAW group and non-ICUAW group according to the MRC-ss score on the 7th day after admission to the ICU. We compared GME，IL-6，and PCT between the two groups，and analyzed their correlations with one another. Receiver operating characteristic（ROC） curves were generated to analyze the diagnostic efficacy and prognostic value of the above parameters for ICUAW. Results The ICUAW group showed a significantly higher GME score on day 3 and a significantly higher IL-6 level and GME score on day 7 compared with the non-ICUAW group（P<0.05）. On day 7，there was a significant positive correlation between the GME score and IL-6 level（r=0.221） and a significant negative correlation between the GME score and MRC-ss score（r=-0.581）. The ROC curve analysis showed that the GME score on day 7 had diagnostic and predictive value for ICUAW，and the area under the ROC curve（AUC） was 0.838； the diagnostic AUC of the combination of GME score，IL-6，and PCT was 0.885（P<0.05）. The Barthel index（BI） score was significantly lower in the ICUAW group than in the non-ICUAW group，and in the ICUAW group，patients with a higher GME score had a significantly lower BI than those with a lower GME score（P<0.05）. Conclusion The GME score is related to plasma IL-6 and PCT levels in ICU patients，showing value for the diagnosis and outcome prediction of ICUAW.

关键词

ICU获得性肌无力 / 肌肉超声回声 / 白细胞介素-6 / 降钙素原 / 医学研究理事会肌力评分法 / 预后

Key words

intensive care unit-acquired weakness / muscle echogenicity / interleukin-6 / procalcitonin / Medical Research Council Scale for Muscle Strength / prognosis

基金资助

重庆市科卫联合资助项目(2022MSXM112)