RU2751972C1 - Method for ultrasound diagnostics of metabolic phenotype of abdominal obesity - Google Patents

Abstract

FIELD: medicine; ultrasound diagnostics.

SUBSTANCE: ultrasound scanning of the subcutaneous fat tissue of the anterior abdominal wall is performed, followed by thickness measurement. Ultrasound scanning of the subcutaneous fat tissue of the anterior abdominal wall is performed in a cross-section perpendicular to the skin surface and the sagittal plane at the middle level of the distance between the symphysis and the navel. The thickness of the deep layer of the subcutaneous fat tissue is measured between the contour of the superficial fascia and the contour of the aponeurosis in the projection of the abdomen white line. If the thickness of the deep layer of the subcutaneous fat tissue is >1.2 cm in women and >1.0 cm in men, the metabolic obese phenotype of obesity is diagnosed.

EFFECT: method allows optimizing diagnostic tactics with minimal time for decision-making, because it allows significantly simplifying diagnostics of the obesity phenotype without conducting a large number of laboratory tests that require blood sampling, and therefore requiring treatment rooms and laboratory equipment; the use of the claimed method will allow for preventive measures at the preclinical or early stage of metabolic disorders, thereby preventing the development of the most important cardiovascular and endocrine diseases that accompany metabolic disorders in obesity.

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Description

The invention relates to medicine, namely to ultrasound diagnosis of obesity, and can be used to diagnose the metabolic phenotype of abdominal obesity.

In accordance with the available modern clinical guidelines for the diagnosis and treatment of obesity, when formulating the diagnosis "Obesity", it is necessary to indicate the presence and degree of obesity by body mass index (BMI), indicate the degree of cardiometabolic risk, and select the metabolic phenotype of obesity (1).

There are two metabolic phenotypes of obesity (MFO) - the metabolically obese phenotype (MTFO) and the metabolically healthy phenotype (MFP) (1). Establishing the metabolic phenotype is the most time consuming task in the diagnosis of obesity. Diagnosis of metabolic disorders requires a large number of laborious, expensive and burdensome for the patient biochemical and immunological studies associated with the patient's blood sampling (2, 3).

Metabolic disorders are diagnosed based on the interpretation of the obtained laboratory tests in accordance with the anthropometric parameters (BMI, OB, OT) identified in the patient and clinical signs of cardiovascular disorders (1, 2, 3).

A known method for predicting the risk of metabolic syndrome (RU No. 2530770, IPC А61В 5/00), including the determination of diagnostic indicators by clinical laboratory and functional methods, followed by the calculation of the prognostic index in the patient. The patient's complex determines the following diagnostic parameters: anthropometric - the Quetelet index, lipid metabolism - the apoprotein coefficient of atherogenicity, the functional state of the liver - alanine aminotransferase, lipid peroxidation - the ratio of malondialdehyde to antioxidant activity, indicators of central hemodynamics - systolic blood pressure and cardiac index. According to the formula, the prognostic index is determined as the total value of the diagnostic indicators determined by clinical, laboratory and functional methods. The obtained value of the prognostic index predicts the absence of risk of developing metabolic syndrome, low risk, medium risk or high risk of developing metabolic syndrome.

The disadvantage of this method is a large volume of laborious, expensive, invasive laboratory tests requiring blood sampling from a patient, a large amount of calculations, which further increases the complexity of diagnosing metabolic disorders.

There is a known method of ultrasound diagnostics of visceral obesity (RF patent No. 2407440, IPC А61В 8/00), including performing oral contrasting of the stomach with 200 ml of degassed liquid and subsequent determination by ultrasound scanning of the thickness of the layer of visceral fat - S (mm) according to the formula S = lh, where l is the distance between the white line of the abdomen and the anterior wall of the aorta, ah is the distance between the walls of the stomach. If S> 30 mm, visceral obesity is diagnosed.

The known method is highly labor intensive and at the same time burdensome for the patient, because requires additional preparation for ultrasound imaging - the creation of an acoustic window from a layer of liquid in the lumen of the stomach, which takes time and the patient's consent, which is not always possible. In addition, in the presence of postoperative scars in the abdominal wall, ventral hernias in the visualization plane and adhesions in the abdominal cavity, incl. after previously performed surgical interventions, a number of diseases of the gastrointestinal tract (GIT) associated with motor-evacuation disorders, the method is inapplicable due to the lack of adequate sound conduction, tk. filling the stomach with liquid does not lead to a significant improvement in sound conduction and tissue visualization.

There is a known method for diagnosing metabolic syndrome by measuring pre-mesenteric fat using an ultrasonic method (patent RU No. 2677526, IPC А61В 8/00), taken as a prototype, which consists in measuring the maximum thickness and width of pre-mesenteric fat and with a thickness of pre-mesenteric fat ≥1.8 cm and / or premesenteric fat width ≥7.0 cm, metabolic syndrome is diagnosed.

The disadvantage of this method is the impossibility of making adequate measurements of premesenteric fat in the presence of scars after performing surgical interventions associated with the performance of the upper median laparotomy, the presence of hernias of the white line of the abdomen, diastasis of the rectus abdominis muscles. Also, the disadvantage of the known method is the significant anatomical variability of the selected object of study, which determines the significant subjective dependence and variability of the measured lipometric characteristics, i.e. its linear geometric parameters. The use of a low-frequency convex sensor in the implementation of the known method does not provide accurate measurements of the linear parameters of the soft tissues of the abdominal wall (in practice, high-frequency linear sensors with a frequency of 7.5-12.0 MHz are used for this), due to an attempt to ensure reliable visualization of preperitoneal tissue at the expense of measurement accuracy due to significant attenuation of ultrasound in soft tissues with a significant thickness of the abdominal wall. The disadvantage is also the dependence of lipometry results on the positioning of the sensor on the anterior abdominal wall. Depending on the position of the sensor chosen by the diagnostician, the lipometric indicators differ significantly, which means that there is a dependence of the research result on subjective factors. The diagnostician himself decides at what distance from the navel (it is only indicated that the sensor is located between the xiphoid process and the navel) and at what angle relative to the sagittal plane to position the sensor (only the angle relative to the skin surface is regulated). In addition, the conclusion about the maximality of the obtained lipometric parameters is subjectively dependent, since the lateral boundaries of the specified layer of preperitoneal tissue do not have clear anatomical landmarks.

The objective of the claimed invention is to improve the accuracy of diagnostics, reduce the complexity and time spent on diagnostics, the possibility of using the method in the screening mode.

The problem is solved by the fact that according to the method of ultrasound diagnostics of the metabolic phenotype of abdominal obesity, including ultrasound scanning of the subcutaneous fatty tissue of the anterior abdominal wall with subsequent measurement of the thickness, ultrasonic scanning of the subcutaneous fatty tissue of the anterior abdominal wall is performed in a transverse section perpendicular to the surface of the skin and the sagittal plane on the level of the middle of the distance between the symphysis and the navel and measure the thickness of the deep layer of subcutaneous fat between the contour of the superficial fascia and the contour of the aponeurosis in the projection of the white line of the abdomen, while the thickness of the deep layer of subcutaneous fat is> 1.2 cm in women and> 1, 0 cm in men is diagnosed with the metabolically obese phenotype of obesity.

The claimed method improves the accuracy of diagnostics with minimal labor, time and material resources, incl. with ambiguously interpreted ("borderline") results of anthropometry, laboratory studies and clinical manifestations, by adopting the thickness of the deep layer of subcutaneous fat (SAD) as a marker of metabolic disorders. The minimum depth of the location of this layer relative to the skin surface creates the most optimal conditions for visualization of the VLC, allows ultrasound examination with high resolution using the most high-frequency transducers, and provides high measurement accuracy with minimal research effort. In addition, the claimed method is technically simple to implement, not picky about the class of an ultrasound scanner and the skills of a diagnostician, and at the same time has a high diagnostic efficiency in assessing the metabolic phenotype of obesity. In fact, the proposed method is an ultrasound anthropometry and is comparable in labor intensity with measuring weight-weight indicators and measuring the circumference of the waist and hips. At the same time, the claimed method allows for the diagnosis of metabolic disorders both in the clinic and during screening studies of the population. It is highly effective at the level of primary health care at the stage of clinical examination or medical examinations, including in field conditions. Moreover, the method is non-invasive and not burdensome for the patient, because does not require any preparation for research, is painless, does not involve the collection of any biological material for laboratory research.

The method is illustrated by the following figures.

FIG. 1 is a diagram of the location of the ultrasound scanner sensor relative to the anatomical landmarks when implementing the claimed method

FIG. 2 is an ultrasound image of the anatomical structures of the soft tissues of the abdominal wall.

FIG. 3 - ultrasound image of the measured structures of the soft tissues of the abdominal wall and the principles of measuring their thickness.

FIG. 1 indicates:

1 - the level of the pubic articulation;

2 - the level of the navel;

3 - median line;

4 - the middle of the distance between the symphysis and the navel;

5 - ultrasound scanner sensor.

FIG. 2 indicates:

6 - leather;

7 - superficial layer of subcutaneous fat;

8 - superficial fascia;

9 - deep layer of subcutaneous fat;

10 - contour of the aponeurosis;

11 - rectus abdominis muscle;

12 - preperitoneal tissue;

13 - the contour of the parietal peritoneum.

FIG. 3 indicates:

14 - contour of the superficial fascia;

15 - contour of the aponeurosis;

L is the thickness of the deep layer of subcutaneous fat.

The method is carried out as follows. Ultrasound examination is performed on a scanner of any class (for example, Aloka SSD-1700) equipped with a high-frequency linear transducer with a scanning frequency of 7.5-10.0 MHz. Ultrasound examination is carried out in the "gray scale" mode. Ultrasound scanning is performed in the supine position using a high-frequency sensor 1 (Fig. 1), installed in the transverse direction perpendicular to the plane of the skin surface and the sagittal plane in the middle of the distance between the symphysis and the navel. Visualize skin 6 (Fig. 2), subcutaneous fatty tissue (SFA), in the thickness of which a sheet of superficial fascia is visualized, dividing the SFA into a surface layer 7 and a deep layer 9, aponeurosis 10, rectus muscles 11 of the anterior abdominal wall, preperitoneal tissue 12 and the contour of the parietal peritoneum 13. The thickness L (Fig. 3) of the deep layer of subcutaneous fat is measured as the distance between the contour 14 of the superficial fascia leaf and the anterior contour 15 of the aponeurosis along the white line of the abdomen. If the thickness of the deep layer of subcutaneous fat is L> 1.2 cm in women and L> 1.0 cm in men, the metabolically obese phenotype of obesity (MTFO) is diagnosed, and if the thickness of the deep layer of subcutaneous fat is less, the metabolically healthy phenotype of obesity (MZFO) is diagnosed.

Example 1. A man with abdominal obesity, 36 years old, height 165 cm, weight 83 kg BMI = 30.49 kg / m ² .

The thickness of the deep layer of subcutaneous fat (L) was 0.9 cm, a metabolically healthy obesity phenotype (MZFO) is diagnosed.

Example 2. A 39-year-old woman with abdominal obesity, height 155 cm, weight 92 kg. BMI = 38.33 kg / m ²

The thickness of the deep layer of subcutaneous fat (L) was 1.1 cm, a metabolically healthy obesity phenotype (MZFO) is diagnosed.

Example 3. Woman, 47 years old with abdominal obesity, Values height 162 cm, weight 112 kg BMI = 42.74 kg / m ² .

The thickness of the deep layer of subcutaneous fat (L) was 1.3 cm, the metabolic obesity phenotype (MTFO) is diagnosed.

Example 4. Male, 56 years old with abdominal obesity, height 169 cm, weight 98 kg BMI = 34.2 kg / m ² .

The thickness of the deep layer of subcutaneous fat (L) was 1.1 cm, the metabolically obese phenotype of obesity (MTFO) is diagnosed.

Thus, the use of the claimed method allows you to optimize the diagnostic tactics with a minimum amount of time to make a decision, because allows you to significantly simplify the diagnosis of the obesity phenotype without carrying out a large number of laboratory tests that require blood sampling, and therefore require treatment rooms and laboratory equipment. The use of the claimed method will make it possible to carry out preventive measures at the preclinical or early stage of metabolic disorders, thereby preventing the development of the most important cardiovascular and endocrine diseases accompanying metabolic disorders in obesity.

Sources of information taken into account when compiling the description:

1. Nedogoda S.V., Barykina I.N., Salasyuk A.S. National Clinical Practice Guidelines for Obesity: A Concept and Perspective. - Bulletin of VolgGMU, 2017, - Issue. 1 (61), p. 134-140.

2. Didenko V.A. Metabolic syndrome: history and etiopathogenesis // Laboratory medicine. 1999. - No. 2. with. 49-56.

3. Nedogoda S.V., Barykina I.N., Salasyuk A.S. and other Recommendations of the All-Russian Scientific Society of Cardiology for the diagnosis and treatment of metabolic syndrome. Second revision // Practical medicine. 2010; 5 (44): p. 81-101.

Claims (1)

A method of ultrasound diagnostics of the metabolic phenotype of abdominal obesity, including ultrasound scanning of the subcutaneous fat of the anterior abdominal wall with subsequent measurement of the thickness, characterized in that ultrasound scanning of the subcutaneous fat of the anterior abdominal wall is performed in a cross section perpendicular to the skin surface and sagittal plane at the mid-distance between the symphysis and the navel and measure the thickness of the deep layer of subcutaneous fat between the contour of the superficial fascia and the contour of the aponeurosis in the projection of the white line of the abdomen, while the thickness of the deep layer of subcutaneous fat is> 1.2 cm in women and> 1.0 cm in men are diagnosed with the metabolically obese obesity phenotype.

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