下肢筋の超音波画像によるサルコペニア評価—サルコペニアと深部静脈血栓症および炎症マーカーとの関連性—

Tsuneo Watanabe; 渡邉恒夫; Hiroko Matsuno; 松野寛子; Ayae Takada; 高田彩永; Koichi Shinoda; 篠田貢一; Yuzuru Nohisa; 野久謙; Hiroyasu Ito; 伊藤弘康; Mitsuru Seishima; 清島満

doi:10.11272/jss.43.692

下肢筋の超音波画像によるサルコペニア評価—サルコペニアと深部静脈血栓症および炎症マーカーとの関連性—Assessment of Sarcopenia by Using Ultrasonographic Imaging of Leg Muscles: The Relationships Between Sarcopenia, Deep Vein Thrombosis, and Inflammatory Markers

渡邉恒夫，松野寛子，高田彩永，篠田貢一，野久謙，伊藤弘康，清島満Tsuneo Watanabe, Hiroko Matsuno, Ayae Takada, Koichi Shinoda, Yuzuru Nohisa, Hiroyasu Ito, Mitsuru Seishima

岐阜大学医学部附属病院検査部Division of Clinical Laboratory, Gifu University Hospital

受付日：2018年3月1日Received: March 1, 2018

受理日：2018年7月10日Accepted: July 10, 2018

発行日：2018年12月1日Published: December 1, 2018

はじめに：加齢に伴う筋肉量，筋力の低下を示す状態をsarcopenia（サルコペニア）と呼ぶ．一方で，深部静脈血栓症（deep vein thrombosis: DVT）は高い罹患率や死亡率に関連した疾患である．本研究では，超音波検査による下腿筋評価とDVT, および炎症マーカーとの関連性について検討することを目的とした．

対象および方法：当院生理検査室にDVTスクリーニング検査として下肢静脈US検査の依頼があった患者72名144肢（平均年齢66.3±14.25歳）を対象とした．これらを非サルコペニア群53例（平均年齢65.8±13.5歳；男性50肢，女性56肢）とサルコペニア群19例（平均年齢67.8±15.8歳；男性8肢，女性30肢）に分類した．超音波検査によって腓腹筋内側頭の筋厚と筋輝度を計測した．

結果：サルコペニア群の55.3%（21/38）にDVTを認め，非サルコペニア群の10.4%（11/106）と比較し高率であった（p＜0.0001）．筋厚はサルコペニア群で有意に減少し，筋輝度は有意に上昇した．加えてtumor necrosis factor-α（TNF-α）は非サルコペニア群に比しサルコペニア群において有意な上昇を認めた（p＝0.014）．

結語：今回の検討においてサルコペニア群では下腿筋厚が有意に減少し，DVT陽性率やTNF-αが有意に高く，サイトカインがサルコペニアの伸展に関与している可能性が示唆された．

Objective. Sarcopenia has been defined as the loss of muscle mass and the reduction of strength that usually progresses with aging. Meanwhile, deep vein thrombosis (DVT) is a common disease associated with high rates of mortality and morbidity. The present study was aimed at evaluating the imaging features of the gastrocnemius muscle (GM) by using sonography and investigating the relationships between sarcopenia and DVT and between sarcopenia and inflammatory markers.

Methods. Seventy-two patients who underwent sonographic examinations of their lower limbs for DVT screenings were enrolled in this study. We included 144 lower limbs from the 72 patients (mean age, 66.3±14.3 years). The subjects were classified into two groups as follows: a non-sarcopenia group (mean age, 65.8±13.5 years, n＝53), and a sarcopenia group (mean age, 67.8±15.8 years, n＝19). The thickness and echo intensity of the GM were measured using ultrasonography.

Results. Of 38 lower limbs in the 19-member sarcopenia group, 21 (55.3%) were positive for DVT. The prevalence of DVT significantly increased in the sarcopenia group as compared with the non-sarcopenia group (10.4%, p＜0.001). The GM echo intensity was significantly higher in the sarcopenia group than in the non-sarcopenia group. GM thickness was significantly greater in the non-sarcopenia group than in the sarcopenia group. In addition, tumor necrosis factor-α (TNF-α) levels were significantly higher in the sarcopenia group than in the non-sarcopenia group (p＝0.014).

Conclusions. Our study shows a signiﬁcant increase in GM echo intensity, TNF-α levels, and DVT prevalence in the sarcopenia group, suggesting that cytokines are involved in the progression of sarcopenia and DVT.

Key words: Sarcopenia; deep vein thrombosis; ultrasonography; muscle echo intensity; inflammatory markers

超音波検査技術

研究Research Paper