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Ультразвуковое исследование мышц для диагностики саркопении у пациентов с воспалительными заболеваниями кишечника
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Akchurina OE, Mukhametova DD, Odintsova AKh, Abdulganieva DI. Ultrasound of muscles for the diagnosis of sarcopenia in patients with inflammatory bowel diseases. Terapevticheskii Arkhiv (Ter. Arkh.). 2025;97(2):157–162. DOI: 10.26442/00403660.2025.02.203204
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Материалы и методы. В исследование включены 102 пациента с ВЗК, госпитализированных в отделение гастроэнтерологии ГАУЗ «Республиканская клиническая больница» (г. Казань). Среди них 49% пациентов с язвенным колитом, 51% – с болезнью Крона, 10 человек составили группу контроля (ГК). Медиана возраста в группе ВЗК – 39,5 [28,5; 50] года, в ГК – 37 [26; 38] лет. В группу ВЗК вошли 52 (51%) женщины, в ГК – 5 (50%). Пациентам проводились обследование с оценкой индекса массы тела (ИМТ), окружности середины плеча (ОСП, см) и окружности середины бедра (ОСБ, см) доминантной стороны; биоимпедансный анализ состава тела на аппарате АВС-02 МЕДАСС; ультразвуковое исследование толщины мышц в двух точках ведущей стороны: ультразвуковая толщина середины плеча (УЗ-СП), ультразвуковая толщина середины бедра (УЗ-СБ), динамометрия с использованием кистевого динамометра, оценка нутритивного статуса.
Результаты. По ИМТ пациенты распределились следующим образом: норма – у 57 (55,9%) больных; дефицит – у 12 (11,8%); избыток – у 25 (24,5%); ожирение – у 8 (7,8%). Медианы ОСП у женщин составили 28 [24,9; 31] см, в ГК – 28 [27; 28,5] см (р>0,05); у мужчин 29,8 [27; 32] см, в ГК – 33 [31; 34] см (p<0,05). Медианы ОСБ у женщин с ВЗК составили 54,25 [48,15; 58,10] см, в ГК – 61,5 [56; 67] см (p<0,05); у мужчин – 48 [46; 51,4] см, в ГК – 54 [53; 54] см (р<0,05). Медианы УЗ-СП у женщин с ВЗК составили 19,60 [18,23; 22,84] мм, ГК – 22,49 [20,41; 22,66] (р>0,05); у мужчин с ВЗК – 26,45 [22,87; 29,24] мм, в ГК – 21,54 [21,18; 25,13] мм (р>0,05). Медианы УЗ-СБ у женщин с ВЗК составили 31,05 [23,21; 37,11] мм, ГК – 41,30 [35,55; 41,74] мм (р<0,05), у мужчин с ВЗК – 30,90 [25,64; 39,99] мм, в ГК – 40,67 [39,10; 41,84] (р<0,05). По результатам биоимпедансометрии индекс скелетно-мышечной массы (иСММ) оказался низким у 32% пациентов, у 65% – в норме, a выше нормы – у 3%. УЗ-СП коррелировала с ОСП (r=0,541; р<0,05), с ИМТ (r=0,448; р<0,05), с иСММ (r=0,666; р<0,05) и динамометрией (r=0,583; р<0,001). УЗ-СБ коррелировала с ОСБ (r=0,533; р<0,05), ИМТ (r=0,421; р<0,05), иСММ (r=0,373; р<0,05) и динамометрией (r=0,226; р=0,027).
Заключение. У пациентов с ВЗК ОСБ оказалась ниже, чем в ГК. УЗ-СБ у женщин и мужчин с ВЗК оказалась меньше, чем в ГК, что коррелировало с ОСБ, ИМТ, массой скелетных мышц по данным биоимпедансометрии и силой хвата по динамометрии.
Ключевые слова: саркопения, воспалительные заболевания кишечника, ультразвуковая диагностика
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Aim. To assess the muscle mass of patients with inflammatory bowel disease (IBD) using ultrasound.
Materials and methods. 102 IBD patients hospitalized in gastroenterology department of Republican Clinical Hospital (Kazan) were involved in the study. Among them, 49% of patients with ulcerative colitis, 51% with Crohn's disease, 10 people made up the control group (CG). The median age in the IBD group was 39.5 [28.5; 50] years, in the CG – 37 [26; 38] years. There were 52 (51%) women in the IBD group and 5 (50%) in the CG group. Patients were examined to assess body mass index (BMI), mid-upper arm circumference (MUAC, cm) and mid-thigh circumference (MTC, cm) of the dominant side; bioimpedance analysis of body composition using the ABC-02 “MEDASS” device; ultrasound examination of muscle thickness at two points on the leading side: ultrasound thickness of the middle of the shoulder (US-MUAC), ultrasound thickness of the middle of the thigh (US-MTC), dynamometry using a wrist dynamometer, assessment of nutritional status.
Results. According to BMI, patients were distributed as follows: normal in 57 (55.9%) patients; deficiency – in 12 (11.8%); overweight – 25 (24.5%); obesity – 8 (7.8%). Median MUAC in women with IBD was 28 [24.9; 31] cm, in CG – 28 [27; 28.5] cm (p>0.05); in men with IBD 29.8 [27; 32] cm, in CG – 33 [31; 34] cm (p<0.05). The median MTC in women with IBD was 54.25 [48.15; 58.10] cm, in CG – 61.5 [56; 67] cm (p<0.05); in men with IBD 48 [46; 51.4] cm, in GC – 54 [53; 54] cm (p<0.05). The median US-MUAC in women with IBD was 19.60 [18.23; 22.84] mm, CG 22.49 [20.41; 22.66] (p>0.05); in men with IBD 26.45 [22.87; 29.24] mm, in CG 21.54 [21.18; 25.13] mm (p>0.05). Median US-MTC in women with IBD was 31.05 [23.21; 37.11] mm, CG 41.30 [35.55; 41.74] mm (p<0.05), in men with IBD 30.90 [25.64; 39.99] mm, in CG 40.67 [39.10; 41.84] (p<0.05). According to the results of bioimpedansometry, the skeletal muscle mass index (SMI) was low in 32% of patients, normal in 65%, and above normal in 3%. US-MUAC correlated with MUAC (r=0.557; p<0.05), with BMI (r=0.448; p<0.05), with SMI (r=0.666; p<0.05). US-MTC correlated with MTC (r=0.505; p<0.05), with BMI (r=0.376; p<0.05), with SMI (r=0.373; p<0.05).
Conclusion. In patients with IBD, MTC was lower than in CG. US-MTC in women and men with IBD was lower than in CG, which correlated with MTC, BMI, skeletal muscle mass according to bioimpedance measurements and grip strength according to dynamometry.
Keywords: sarcopenia, inflammatory bowel diseases, ultrasound diagnostics
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3. Nishikawa H, Nakamura S, Miyazaki T, et al. Inflammatory Bowel Disease and Sarcopenia: Its Mechanism and Clinical Importance. J Clin Med. 2021;10(18):4214. DOI:10.3390/jcm10184214
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10. Perkisas S, Bastijns S, Baudry S, et al. Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update. Eur Geriatr Med. 2021;12(1):45-59. DOI:10.1007/s41999-020-00433-9
11. Haskey N, Peña-Sánchez JN, Jones JL, Fowler SA. Development of a screening tool to detect nutrition risk in patients with inflammatory bowel disease. Asia Pac J Clin Nutr. 2018;27(4):756-62. DOI:10.6133/apjcn.112017.01
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15. Bin CM, Flores C, Alvares-da-Silva MR, Francesconi CF. Comparison between handgrip strength, subjective global assessment, anthropometry, and biochemical markers in assessing nutritional status of patients with Crohn's disease in clinical remission. Dig Dis Sci. 2010;55(1):137-44. DOI:10.1007/s10620-008-0692-1
16. Jabłońska B, Mrowiec S. Nutritional Status and Its Detection in Patients with Inflammatory Bowel Diseases. Nutrients. 2023;15(8):1991. DOI:10.3390/nu15081991
17. Nguyen AL, Herath M, Burns M, et al. The value of whole-body dual-energy x-ray absorptiometry in assessing body composition in patients with inflammatory bowel disease: a prospective study. Eur J Gastroenterol Hepatol. 2024;36(1):52-61. DOI:10.1097/MEG.0000000000002675
18. Zhang Y, Zhang L, Gao X, et al. Impact of malnutrition and sarcopenia on quality of life in patients with inflammatory bowel disease: A multicentre study. J Cachexia Sarcopenia Muscle. 2023;14(6):2663-75. DOI:10.1002/jcsm.13341
19. Buckinx F, Landi F, Cesari M, et al. Pitfalls in the measurement of muscle mass: a need for a reference standard. J Cachexia Sarcopenia Muscle. 2018;9(2):269-78. DOI:10.1002/jcsm.12268
20. Ashton JJ, Peiris D, Green Z, et al. Routine abdominal magnetic resonance imaging can determine psoas muscle area in paediatric Crohn's disease and correlates with bioelectrical impedance spectroscopy measures of lean mass. Clin Nutr ESPEN. 2021;42:233-8. DOI:10.1016/j.clnesp.2021.01.031
21. Gettigan N, Saeidi R, Hanley M, et al. Validation of anterior thigh ultrasound for screening of sarcopenia and elevated body fat in Inflammatory Bowel Disease. Journal of Crohn's and Colitis. 2023;17(suppl. 1):i488-9. DOI:10.1093/ecco-jcc/jjac190.0481
22. Fichera A, Costantino A, Piagnani A, et al. P248 Feasibility, accuracy and reproducibility of the ultrasound measurement of psoas muscle compared to bioelectrical impedance analysis for the evaluation of skeletal muscle mass in patients with IBD. J Crohn's Colitis. 2024;18(suppl. 1):i599-600. DOI:10.1093/ecco-jcc/jjad212.0378
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1. Ryan E, McNicholas D, Creavin B, et al. Sarcopenia and Inflammatory Bowel Disease: A Systematic Review. Inflamm Bowel Dis. 2019;25(1):67-73. DOI:10.1093/ibd/izy212
2. Dhaliwal A, Quinlan JI, Overthrow K, et al. Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview. Nutrients. 2021;13(2):656. DOI:10.3390/nu13020656
3. Nishikawa H, Nakamura S, Miyazaki T, et al. Inflammatory Bowel Disease and Sarcopenia: Its Mechanism and Clinical Importance. J Clin Med. 2021;10(18):4214. DOI:10.3390/jcm10184214
4. Scaldaferri F, Pizzoferrato M, Lopetuso LR, et al. Nutrition and IBD: Malnutrition and/or Sarcopenia? A Practical Guide. Gastroenterol Res Pract. 2017;2017:8646495. DOI:10.1155/2017/8646495
5. Bikbavova GR, Livzan MA, Lisyutenko NS, Romanyuk AE. Pathomorphosis of ulcerative colitis: from body weight deficiency to sarcopenic obesity. Experimental and Clinical Gastroenterology. 2023;218(10):57-62 (in Russian). DOI:10.31146/1682-8658-ecg-218-10-57-62
6. Grillot J, D'Engremont C, Parmentier AL, et al. Sarcopenia and visceral obesity assessed by computed tomography are associated with adverse outcomes in patients with Crohn's disease. Clin Nutr. 2020;39(10):3024-30. DOI:10.1016/j.clnu.2020.01.001
7. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. DOI:10.1093/ageing/afy169
8. Mulinacci G, Pirola L, Gandola D, et al. Ultrasound muscle assessment for sarcopenia detection in inflammatory bowel disease: A prospective study. United European Gastroenterol J. 2024;12(5):562-73. DOI:10.1002/ueg2.12566
9. Calvez V, Becherucci G, Covello C, et al. Navigating the Intersection: Sarcopenia and Sarcopenic Obesity in Inflammatory Bowel Disease. Biomedicines. 2024;12(6):1218. DOI:10.3390/biomedicines12061218
10. Perkisas S, Bastijns S, Baudry S, et al. Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update. Eur Geriatr Med. 2021;12(1):45-59. DOI:10.1007/s41999-020-00433-9
11. Haskey N, Peña-Sánchez JN, Jones JL, Fowler SA. Development of a screening tool to detect nutrition risk in patients with inflammatory bowel disease. Asia Pac J Clin Nutr. 2018;27(4):756-62. DOI:10.6133/apjcn.112017.01
12. Singh A, Midha V, Mahajan R, et al. Evaluation of Nutritional Characteristics Reveals Similar Prevalence of Malnutrition in Patients with Ulcerative Colitis and Crohn's Disease. Dig Dis Sci. 2023;68(2):580-95. DOI:10.1007/s10620-022-07652-z
13. Bikbavova GR, Livzan MA, Drapkina OM, et al. Sarcopenia and Dinapenia in Patients with Ulcerative Colitis (Cross-Sectional Observational Study). Annals of the Russian Academy of Medical Sciences. 2024;79(2):112-22 (in Russian). DOI:10.15690/vramn17389
14. Navarro G, Gómez-Autet M, Morales P, et al. Homodimerization of CB2 cannabinoid receptor triggered by a bivalent ligand enhances cellular signaling. Pharmacol Res. 2024;208:107363. DOI:10.1016/j.phrs.2024.107363
15. Bin CM, Flores C, Alvares-da-Silva MR, Francesconi CF. Comparison between handgrip strength, subjective global assessment, anthropometry, and biochemical markers in assessing nutritional status of patients with Crohn's disease in clinical remission. Dig Dis Sci. 2010;55(1):137-44. DOI:10.1007/s10620-008-0692-1
16. Jabłońska B, Mrowiec S. Nutritional Status and Its Detection in Patients with Inflammatory Bowel Diseases. Nutrients. 2023;15(8):1991. DOI:10.3390/nu15081991
17. Nguyen AL, Herath M, Burns M, et al. The value of whole-body dual-energy x-ray absorptiometry in assessing body composition in patients with inflammatory bowel disease: a prospective study. Eur J Gastroenterol Hepatol. 2024;36(1):52-61. DOI:10.1097/MEG.0000000000002675
18. Zhang Y, Zhang L, Gao X, et al. Impact of malnutrition and sarcopenia on quality of life in patients with inflammatory bowel disease: A multicentre study. J Cachexia Sarcopenia Muscle. 2023;14(6):2663-75. DOI:10.1002/jcsm.13341
19. Buckinx F, Landi F, Cesari M, et al. Pitfalls in the measurement of muscle mass: a need for a reference standard. J Cachexia Sarcopenia Muscle. 2018;9(2):269-78. DOI:10.1002/jcsm.12268
20. Ashton JJ, Peiris D, Green Z, et al. Routine abdominal magnetic resonance imaging can determine psoas muscle area in paediatric Crohn's disease and correlates with bioelectrical impedance spectroscopy measures of lean mass. Clin Nutr ESPEN. 2021;42:233-8. DOI:10.1016/j.clnesp.2021.01.031
21. Gettigan N, Saeidi R, Hanley M, et al. Validation of anterior thigh ultrasound for screening of sarcopenia and elevated body fat in Inflammatory Bowel Disease. Journal of Crohn's and Colitis. 2023;17(suppl. 1):i488-9. DOI:10.1093/ecco-jcc/jjac190.0481
22. Fichera A, Costantino A, Piagnani A, et al. P248 Feasibility, accuracy and reproducibility of the ultrasound measurement of psoas muscle compared to bioelectrical impedance analysis for the evaluation of skeletal muscle mass in patients with IBD. J Crohn's Colitis. 2024;18(suppl. 1):i599-600. DOI:10.1093/ecco-jcc/jjad212.0378
1ФГБОУ ВО «Казанский государственный медицинский университет» Минздрава России, Казань, Россия;
2ГАУЗ «Республиканская клиническая больница» Минздрава Республики Татарстан, Казань, Россия
*olya-akchurina@mail.ru
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Olga E. Akchurina*1, Dilyara D. Mukhametova1, Alfiya Kh. Odintsova2, Diana I. Abdulganieva1,2
1Kazan State Medical University, Kazan, Russia;
2Republican Clinical Hospital, Kazan, Russia;
*olya-akchurina@mail.ru