骨骼肌超声检查联合生物电阻抗分析在肿瘤脓毒症患者重症监护室获得性衰弱中的诊断价值

doi:10.3969/j.issn.1006-5725.2026.01.003

Abstract

Abstract:

Objective To explore the application of rectus femoris cross-sectional area （RF-CSA）， Tibialis anterior muscle thickness （TA-MT）， and bioelectrical-impedance-analysis （BIA） in the diagnosis of intensive care unit-acquired weakness （ICU-AW）. Methods A single-centre， observational study was carried out on 116 patients who were admitted to the Intensive Care Unit （ICU） of Tianjin Medical University Cancer Hospital because of tumour-related sepsis or septic shock. By examining the patients' general clinical data and using ultrasound and bioimpedance analysis to monitor the changes in indicators such as rectus femoris， tibialis anterior， skeletal muscle index （SMI）， total body water （TBW）， and protein content within 6 hours after the onset of sepsis and 72 hours after the initiation of sepsis treatment， statistical analysis was performed to predict the probability of ICU-AW occurrence. Results Ultimately， a total of 41 patients were diagnosed with ICU-AW. Patients with ICU-AW had a higher proportion of vasoactive drug use and mechanical ventilation， along with elevated Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） and Sequential Organ Failure Assessment （SOFA） scores， which clearly indicated a more severe state of illness. Moreover， group-by-group comparisons showed more significant decreases in RF-CSA， TA-MT， SMI， TBW， and protein content （Protein） in the ICU-AW group （P < 0.05）. In addition， compared to the non-ICU-AW group， ICU-AW patients had lower initial mean Passive Angle （PA） values （3.42° vs. 3.80°） and showed a more rapid increase in PA after aggressive intervention. When it came to the diagnosis of ICU-AW， the change rates of RF-CSA， TA-MT， SMI， TBW， and Protein presented higher Receiver Operating Characteristic-Area Under the Curve （ROC-AUC） values for diagnosing ICU-AW ［0.891 （95%CI： 0.831 ~ 0.952）， 0.830 （95%CI： 0.749 ~ 0.911）， 0.916 （95%CI： 0.862 ~ 0.971）， 0.833 （95%CI： 0.749 ~ 0.917）， and 0.834 （95%CI： 0.758 ~ 0.911）， respectively］. Furthermore， the initial APACHE Ⅱ score showed good diagnostic value， with a ROC-AUC of 0.829 （95%CI： 0.803 ~ 0.917）. In the combined diagnostic model， the joint model that included the SMI change rate and Protein change rate measured by bioimpedance analysis achieved the highest ROC-AUC （0.938， 95%CI 0.895 ~ 0.980）. Conclusion Peripheral muscle ultrasound and bioelectrical impedance analysis can be employed as effective tools for the early detection of ICU-AW in patients with tumor sepsis.

Key words: ICU-acquired weakness, rectus femoris, tibialis anterior, bioelectrical impedance analysis, tumor, sepsis

CLC Number:

R459.7

Zhen ZHANG,Donghao WANG,Yang LV. Diagnostic value of skeletal muscle ultrasonography combined with bioelectrical impedance analysis in acquired weakness in the intensive care unit of patients with tumor sepsis[J]. The Journal of Practical Medicine, 2026, 42(1): 21-28.

Figures/Tables 7

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Fig.2

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References 25

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变量	No ICU-AW组（n = 75）	ICU-AW组（n = 41）	t/χ²值	P值
性别			0.511	0.475
男	70（81.4）	38（86.4）
女	16（18.6）	6（13.6）
年龄（x ± s）/岁	66.43 ± 8.45	66.31 ± 10.03	-0.047	0.962
BMI（x ± s）/（kg/cm²）	23.54 ± 4.39	23.97 ± 2.91	0.362	0.719
肿瘤类型			2.457	0.483
食管癌	28（32.6）	19（43.2）
胃癌	25（29.1）	13（29.5）
结肠癌	15（17.4）	7（15.9）
其他	18（20.9）	5（11.4）
感染部位			3.295	0.348
腹腔感染	32（37.2）	15（34.1）
肺炎	28（32.6）	19（43.2）
胸腔感染	17（19.8）	4（9.1）
其他	9（10.4）	6（13.6）
使用血管活性药物	29（33.7）	32（72.7）	17.782	< 0.001
使用机械通气	35（40.7）	30（68.2）	8.795	0.003
使用镇痛镇静	62（72.1）	37（84.1）	2.307	0.129
乳酸（x ± s）/（mmol/L）	1.90 ± 0.79	2.13 ± 1.32	0.813	0.419
NRS2002评分（x ± s）/分	4.13 ± 1.02	4.42 ± 1.44	0.328	0.637

指标	No ICU-AW组（n = 75）	ICU-AW 组（n = 41）	t值	P值	指标	No ICU-AW组（n = 75）	ICU-AW 组（n = 41）	t值	P值
股直肌横截面积/cm²					SOFA 评分
D0h	4.37 ± 0.74	4.36 ± 0.87	0.081	0.936	D0h	5.44 ± 2.64	8.27 ± 3.41	-4.965	< 0.001
D72h	4.19 ± 0.78	3.87 ± 0.81	2.122	0.036	D72h	3.05 ± 2.23	4.02 ± 3.62	-1.789	0.076
t值	6.872	13.250			t值	8.848	9.768
P′值	< 0.001	< 0.001			P′值	< 0.001	< 0.001
胫骨前肌厚度/cm					全身水/L
D0h	2.19 ± 0.30	2.27 ± 0.34	-1.274	0.205	D0h	37.68 ± 5.94	40.91 ± 6.37	-2.732	0.007
D72h	2.08 ± 0.29	2.04 ± 0.30	0.688	0.493	D72h	36.00 ± 5.70	36.59 ± 6.06	-0.525	0.601
t值	6.876	10.117			t值	8.442	10.552
P′值	< 0.001	< 0.001			P′值	< 0.001	< 0.001
骨骼肌指数/（kg/m²）					蛋白质质量/kg
D0h	7.52 ± 1.11	8.21 ± 1.31	-2.982	0.003	D0h	9.64 ± 1.52	10.40 ± 1.60	-2.530	0.013
D72h	7.13 ± 1.08	6.99 ± 1.14	0.663	0.509	D72h	9.27 ± 1.47	9.42 ± 1.52	-0.537	0.592
t值	11.675	13.350			t值	8.290	12.036
P′值	< 0.001	< 0.001			P′值	< 0.001	< 0.001
上臂围/cm					（细胞外水/全身水）/%
D0h	29.98 ± 2.55	30.70 ± 3.56	-1.254	0.212	D0h	40.85 ± 1.12	41.21 ± 1.66	-1.376	0.172
D72h	29.74 ± 2.61	30.73 ± 5.51	-1.316	0.191	D72h	40.36 ± 1.54	40.40 ± 1.23	-0.139	0.890
t值	1.552	-0.040			t值	5.019	2.875
P′值	0.125	0.968			P′值	< 0.001	0.006
APACHEⅡ评分					相位角/°
D0h	14.11 ± 3.51	22.07 ± 6.93	-8.235	< 0.001	D0h	3.80 ± 0.86	3.42 ± 0.71	2.406	0.018
D72h	10.15 ± 3.58	11.59 ± 5.21	-1.754	0.082	D72h	4.22 ± 1.06	4.10 ± 0.98	0.567	0.572
t值	8.750	10.331			t值	-7.561	-5.601
P′值	< 0.001	< 0.001			P′值	< 0.001	< 0.001

变量	SE	P值	ROC-AUC（95%CI）
△MUAC	0.055	0.007	0.652（0.545 ~ 0.760）
△RF-CSA	0.031	< 0.001	0.891（0.831 ~ 0.952）
△TA-MT	0.041	< 0.001	0.830（0.749 ~ 0.911）
△SMI	0.028	< 0.001	0.916（0.862 ~ 0.971）
△TBW	0.043	< 0.001	0.833（0.749 ~ 0.917）
△ECW/TBW	0.051	< 0.001	0.711（0.610 ~ 0.811）
△PA	0.053	< 0.001	0.712（0.609 ~ 0.815）
△Protein	0.039	< 0.001	0.834（0.758 ~ 0.911）
APACHE II-D0h	0.029	< 0.001	0.829（0.803 ~ 0.917）
SOFA-D0h	0.047	< 0.001	0.743（0.651 ~ 0.834）
△SMI+△Protein	0.022	< 0.001	0.938（0.895 ~ 0.980）
△RF-CSA+△TA-MT	0.030	< 0.001	0.894（0.834 ~ 0.954）
APACHE Ⅱ+SOFA-D0h	0.029	< 0.001	0.842（0.806 ~ 0.918）

变量	截断值	敏感度	特异度	阳性预测值	阴性预测值	约登指数
△MUAC	0.013	0.756	0.600	0.508	0.818	0.356
△RF-CSA	0.054	0.951	0.813	0.736	0.968	0.789
△TA-MT	0.053	0.902	0.760	0.672	0.934	0.649
△SMI	0.095	0.829	0.893	0.810	0.905	0.747
△TBW	0.071	0.805	0.813	0.702	0.884	0.618
△ECW/TBW	0.017	0.707	0.693	0.558	0.813	0.401
△PA	0.091	0.854	0.520	0.493	0.867	0.360
△Protein	0.063	0.805	0.773	0.660	0.879	0.603
APACHE II-D0h	16.50	0.829	0.587	0.523	0.863	0.656
SOFA-D0h	5.50	0.829	0.520	0.486	0.848	0.349
△RF-CSA +△TA-MT	0.286	0.976	0.813	0.741	0.984	0.789
△SMI+△Protein	0.467	0.854	0.933	0.875	0.921	0.787
APACHE II+SOFA-D0h	0.281	0.854	0.827	0.729	0.912	0.680

Diagnostic value of skeletal muscle ultrasonography combined with bioelectrical impedance analysis in acquired weakness in the intensive care unit of patients with tumor sepsis

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