Диагностическая и прогностическая значимость анализа композиционного состава тела с применением методов медицинской визуализации у женщин в постменопаузе: обзор

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Аннотация

В статье представлена оценка маркёров композиционного состава тела у женщин в период постменопаузы и старения, полученных с помощью методов медицинской визуализации в условиях реальной клинической практики. С возрастом состав тела меняется, что особенно заметно в период менопаузы, когда в организме женщины происходят эндокринные изменения. В научной практике для оценки композиционного состава тела используют определённые визуализационные маркёры. В настоящем обзоре проанализированы связи различных визуализационных показателей с риском развития кардиометаболических нарушений и других заболеваний с учётом их влияния на частоту развития сопутствующих заболеваний и смертность, развитие функциональных нарушений и старческой астении. Особое внимание уделено визуализационным маркёрам, диагностическая эффективность которых подтверждена, что позволяет их использовать в условиях клинической практики. С этой целью проанализированы публикации, содержащие актуальные доказательные данные о надёжности исследуемых маркёров и их возможной связи с другими факторами.

В обзоре рассмотрены возможности для улучшения тактики ведения женщин в постменопаузе, изучения их жизненных потребностей и профилактики или снижения степени выраженности неблагоприятного старения и частоты развития возрастных заболеваний посредством применения существующих методов медицинской визуализации (например, двухэнергетической рентгеновской абсорбциометрии, ультразвукового исследования, компьютерной томографии и магнитно-резонансной томографии) при целенаправленном исследовании композиционного состава тела и проведении исследований по другим клиническим показаниям с получением соответствующих данных.

Об авторах

Maria Pilar Aparisi Gómez

Te Toka Tumai Auckland (Auckland District Health Board); Waipapa Taumata Rau — University of Auckland

Email: pilar.aparisi@tewhatuora.govt.nz
ORCID iD: 0000-0002-6483-7139
Новая Зеландия, Окленд; Окленд

Miriana Rosaria Petrera

National Institute for Infectious Disease «Lazzaro Spallanzani»

Email: mirianapetrera@gmail.com
ORCID iD: 0000-0002-1275-6265
Италия, Рим

Aurelia Santoro

University of Bologna, Sant'Orsola-Malpighi Hospital

Email: aurelia.santoro@unibo.it
ORCID iD: 0000-0002-7187-1116

доцент

Италия, Болонья

Maria Letizia Petroni

University of Bologna, Sant'Orsola-Malpighi Hospital

Email: marialetizia.petroni@unibo.it
ORCID iD: 0000-0002-7040-6466

доцент

Италия, Болонья

Chiara Gasperini

IRCCS Istituto Ortopedico Rizzoli

Email: chiara.gasperini@unibo.it
ORCID iD: 0000-0002-5306-0985
Италия, Болонья

Claudio Franceschi

University of Bologna, Sant'Orsola-Malpighi Hospital

Email: claudio.franceschi@unibo.it
ORCID iD: 0000-0001-9841-6386

профессор

Италия, Болонья

Giulio Marchesini

University of Bologna, Sant'Orsola-Malpighi Hospital

Email: giulio.marchesini@unibo.it
ORCID iD: 0000-0003-2407-9860

профессор

Италия, Болонья

Giuseppe Guglielmi

University of Foggia; «IRCCS Casa Sollievo della Sofferenza» Hospital

Автор, ответственный за переписку.
Email: giuseppe.guglielmi@unifg.it
ORCID iD: 0000-0002-4325-8330

профессор

Италия, Фоджа; Сан-Джованни-Ротондо

Alberto Bazzocchi

IRCCS Istituto Ortopedico Rizzoli

Email: abazzocchi@gmail.com
ORCID iD: 0000-0002-2659-4535
Италия, Болонья

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2. Рис. 1. Анализ композиционного состава тела с применением двухэнергетической рентгеновской абсорбциометрии. Измерения основаны на трёхкомпонентной модели, которую в целях упрощения можно представить в виде жировой массы (ЖМ — жёлтый цвет), тощей массы, исключая кости (ТМ — красный цвет), и костного минерального содержания (КМС — белый цвет). При исследовании всего тела и отдельных областей можно оценить массу тела и минеральную плотность костной ткани.

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3. Рис. 2. Линейные измерения жировой ткани по данным ультразвукового исследования и компьютерной томографии: a — минимальная толщина подкожного жира живота (MinASFT) определяется как расстояние между передней поверхностью белой линии живота и дермо-гиподермальным переходом (1), измеренное в плоскости, проходящей через подмечевидную область. Толщину предбрюшинного жира (2) измеряют от передней поверхности брюшины, покрывающей печень, до задней поверхности белой линии живота в плоскости, проходящей через подмечевидную область; b — максимальная толщина подкожного жира живота (MaxASFT) определяется как расстояние между передней поверхностью белой линии живота и дермо-гиподермальным переходом (3), измеренное на уровне надпупочной области. Толщину внутрибрюшного жира принято измерять как расстояние от задней стенки брюшной мышцы до передней стенки аорты в надпупочной области (4).

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4. Рис. 3. Измерение площади различных жировых компартментов с применением магнитно-резонансной томографии: a — изображение, полученное в режиме T1-взвешенного быстрого спин-эха (T1-weighted Fast Spin Echo) на уровне II–III поясничных позвонков; b — сегментация подкожной жировой ткани (оранжевый цвет), висцеральной жировой ткани (жёлтый цвет) и нежировой ткани (синий цвет). Газ в петлях кишечника визуализируется как области чёрного цвета, а костная ткань — как области белого цвета.

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