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1.
绝经后女性肌少症   总被引:1,自引:0,他引:1       下载免费PDF全文
肌少症为老龄化进展过程中以骨骼肌质量及力量下降为特征的临床综合征,并伴有残疾、生活质量降低甚至死亡,在老年人群中广泛存在,严重影响老年人的生活质量,是当今社会重要的公共健康问题。目前国际上关于肌少症的诊断及筛查方法尚未统一,多个组织先后制定了肌少症共识,提出肌少症的诊断切点,临床实践中使用握力、步速等方法来评估老年人肌肉情况。绝经是一种与年龄相关的生理状况,与自然衰退的雌激素水平相关,易导致肌肉质量和力量的降低,增加肌少症患病率。绝经后女性肌肉组织的质量、功能以及肌肉组织的成分发生变化与雌激素水平降低有关,还受营养、运动、环境、遗传等其他多种复杂因素影响,目前尚没有明确关于肌少症的治疗药物,但现有证据认为阻抗运动、膳食营养、性激素替代治疗等对于改善老年绝经后女性肌肉的质量及力量具有重要作用。目前绝经与肌少症的关系还处于探索阶段,仍有许多值得进一步研究的问题,本文就肌少症的诊断及绝经后激素变化和增龄与肌少症的关系等进行综述。  相似文献
2.
Body composition and muscle function have important implications for falls and fractures in older adults. We aimed to investigate longitudinal associations between sarcopenic obesity and its components with bone mineral density (BMD) and incident falls and fractures in Australian community‐dwelling older men. A total of 1486 men aged ≥70 years from the Concord Health and Ageing in Men Project (CHAMP) study were assessed at baseline (2005–2007), 2‐year follow‐up (2007–2009; n = 1238), and 5‐year follow‐up (2010–2013; n = 861). At all three time points, measurements included appendicular lean mass (ALM), body fat percentage and total hip BMD, hand‐grip strength, and gait speed. Participants were contacted every 4 months for 6.1 ± 2.1 years to ascertain incident falls and fractures, the latter being confirmed by radiographic reports. Sarcopenic obesity was defined using sarcopenia algorithms of the European Working Group on Sarcopenia (EWGSOP) and the Foundation for the National Institutes of Health (FNIH) and total body fat ≥30% of total mass. Sarcopenic obese men did not have significantly different total hip BMD over 5 years compared with non‐sarcopenic non‐obese men (p > 0.05). EWGSOP‐defined sarcopenic obesity at baseline was associated with significantly higher 2‐year fall rates (incidence rate ratio [IRR] 1.66; 95% confidence interval [CI] 1.16–2.37), as were non‐sarcopenic obesity (1.30; 1.04–1.62) and sarcopenic non‐obesity (1.58; 1.14–2.17), compared with non‐sarcopenic non‐obese. No association with falls was found for sarcopenic obesity using the FNIH definition (1.01; 0.63–1.60), but after multivariable adjustment, the FNIH‐defined non‐sarcopenic obese group had a reduced hazard for any 6‐year fracture compared with sarcopenic obese men (hazard ratio 0.44; 95% CI 0.23–0.86). In older men, EWGSOP‐defined sarcopenic obesity is associated with increased fall rates over 2 years, and FNIH‐defined sarcopenic obese men have increased fracture risk over 6 years compared with non‐sarcopenic obese men. © 2016 American Society for Bone and Mineral Research.  相似文献
3.
Age‐related loss of skeletal muscle mass and strength are risk factors for sarcopenia, osteoporosis, falls, fractures, frailty, and mortality. Dietary magnesium (Mg) could play a role in prevention of age‐related loss of skeletal muscle mass, power, and strength directly through physiological mechanisms or indirectly through an impact on chronic low‐grade inflammation, itself a risk factor for loss of skeletal muscle mass and strength. In a cross‐sectional study of 2570 women aged 18 to 79 years, we examined associations between intakes of Mg, estimated using a food‐frequency questionnaire (FFQ), dual‐energy X‐ray absorptiometry (DXA)‐derived measures of muscle mass (fat‐free mass as a percentage of body weight [FFM%], fat‐free mass index [FFMI, kg/m2]), leg explosive power (LEP), and grip strength (n = 949 only). We also examined associations between circulating hs‐CRP (C‐reactive protein) and muscle mass and LEP, and explored the potential attenuation of these relationships by Mg. We compared our findings with those of age and protein intake. Endpoints were calculated by quintile of Mg and adjusted for relevant confounders. Significant positive associations were found between a higher Mg and indices of skeletal muscle mass and LEP, and also with hs‐CRP, after adjustment for covariates. Contrasting extreme quintiles of Mg intake showed differences of 2.6% for FFM% (p trend < 0.001), 0.4 kg/m2 for FFMI (p trend = 0.005), and 19.6 watts/kg for LEP (p trend < 0.001). Compared with protein, these positive associations were 7 times greater for FFM% and 2.5 times greater for LEP. We also found that higher hs‐CRP was negatively associated with skeletal muscle mass and, in statistical modeling, that a higher dietary Mg attenuated this negative relationship by 6.5%, with greater attenuation in women older than 50 years. No association was found between Mg and grip strength. Our results suggest that dietary magnesium may aid conservation of age‐related loss of skeletal muscle mass and power in women of all ages. © 2015 American Society for Bone and Mineral Research.  相似文献
4.
Recently, we have begun to realize that the billions of microorganisms living in symbiosis with us have an influence on disease. Evidence is mounting that the alimentary tract microbiome, in particular, influences both host metabolic potential and its innate and adaptive immune system. Inflammatory states characterize many bone and joint diseases of aging. This prompts the hypothesis that the gut microbiome could alter the inflammatory state of the individual and directly influence the development of these common and burdensome clinical problems. Because the microbiome is easily modifiable, this could have major therapeutic impact. This perspective discusses evidence to date on the role of the microbiome and the highly prevalent age‐related disorders of osteoporosis, osteoarthritis, gout, rheumatoid arthritis, sarcopenia, and frailty. It also reviews data on the effects of probiotics and prebiotic interventions in animal and human models. Despite suggestive findings, research to date is not conclusive, and we identify priorities for research to substantiate and translate findings. © 2015 American Society for Bone and Mineral Research.  相似文献
5.
Whether low muscle mass predisposes to fracture is still poorly understood. In the diagnosis of sarcopenia, different thresholds for low lean mass have been proposed but comparative data for these criteria against hard outcomes such as fractures are lacking. This study aimed to investigate the prevalence of low lean mass according to different thresholds used in operational definitions of sarcopenia and their association with 3‐year fracture incidence in a cohort of healthy 63‐ to 67‐year‐old community dwellers. In a longitudinal analysis of 913 participants (mean age 65.0 ± 1.4 years) enrolled in the Geneva Retirees Cohort (GERICO) study, lean mass was assessed by dual‐energy X‐ray absorptiometry (DXA), and low trauma clinical fracture incidence was recorded over a 3‐year period. Prevalence of low lean mass ranged from 3.5% to 20.2% according to the threshold applied. During a follow‐up of 3.4 ± 0.9 years, 40 (4.4%) participants sustained at least one low trauma fracture. After multivariate adjustment including Fracture Risk Assessment Tool (FRAX) probability with femoral neck bone mineral density (BMD), low lean mass, as defined by Baumgartner thresholds, was associated with higher fracture risk (odds ratio [OR], 2.32; 95% CI, 1.04 to 5.18; p = 0.040). It also added significant predictive value beyond FRAX (likelihood ratio test for nested models, 4.28; p < 0.039). No significant association was found for other definition thresholds. The coexistence of sarcopenia and a T‐score <–2.5 at spine or hip was associated with a 3.39‐fold (95% CI, 1.54 to 7.46; p = 0.002) increase in low trauma fracture risk. In conclusion, low lean mass, as defined by the Baumgartner thresholds, is a predictor of incident fractures in a large cohort of healthy 65‐year‐old community dwellers, independently of FRAX probability. The increased risk is related to the threshold for low lean mass selected. These findings suggest that identification of sarcopenia should be considered in fracture risk assessment beyond usual risk factors. © 2016 American Society for Bone and Mineral Research.  相似文献
6.
目的 探讨维持性血液透析患者营养不良-炎症综合征与肌少症之间的关系.方法 选择2014年10月至2015年12月在云南省肾脏病医院及昆明医科大学第一附属医院接受维持性血液透析患者55例,所有入组患者均用MIS评分法进行营养不良-炎症综合征的评估,应用生物电阻抗法进行肌肉质量测量,采用电子握力计测量肌力,空腹检测血生化指标.结果 本研究中肌少症患者26例(47.3%),其中肌少症前期患者10例(18.2%),肌少症期16例(29%),无肌少症29例(52.7%);肌少症前期、肌少症期、无肌少症三组患者年龄、性别差异有统计学意义(P<0.05).按MIS得分将患者分为轻度(0~4分)、中度(5~8分)、重度(>8分)三组.MIS评分与骨骼肌质量、骨骼肌质量指数、握力呈负相关(P<0.05).不同MIS组间骨骼肌质量、骨骼肌质量指数、握力平均值差异有统计学意义(P<0.05).结论 本组患者肌少症与患者年龄、性别相关.随着营养不良炎症得分增加,骨骼肌质量、骨骼肌质量指数及握力平均值呈下降趋势.改善维持性血液透析患者营养不良炎症状态可能会降低肌少症的发生.  相似文献
7.
Bone fractures markedly reduce quality of life and life expectancy in elderly people. Although osteoporosis increases bone fragility, fractures frequently occur in patients with normal bone mineral density. Because most fractures occur on falling, preventing falls is another focus for reducing bone fractures. In this study, we investigated the role of vitamin D receptor (VDR) signaling in locomotive ability. In the rotarod test, physical exercise enhanced locomotive ability of wild‐type (WT) mice by 1.6‐fold, whereas exercise did not enhance locomotive ability of VDR knockout (KO) mice. Compared with WT mice, VDR KO mice had smaller peripheral nerve axonal diameter and disordered AChR morphology on the extensor digitorum longus muscle. Eldecalcitol (ED‐71, ELD), an analog of 1,25(OH)2D3, administered to rotarod‐trained C57BL/6 mice enhanced locomotor performance compared with vehicle‐treated nontrained mice. The area of AChR cluster on the extensor digitorum longus was greater in ELD‐treated mice than in vehicle‐treated mice. ELD and 1,25(OH)2D3 enhanced expression of IGF‐1, myelin basic protein, and VDR in rat primary Schwann cells. VDR signaling regulates neuromuscular maintenance and enhances locomotive ability after physical exercise. Further investigation is required, but Schwann cells and the neuromuscular junction are targets of vitamin D3 signaling in locomotive ability. © 2014 American Society for Bone and Mineral Research.  相似文献
8.
Sarcopenia, the age‐related loss of muscle mass and strength, is a major cause of impaired physical function, which contributes to mobility disability, falls and hospitalizations in older adults. Lower muscle mass and strength are also associated with lower bone mineral density and greater risk for osteoporotic fractures. Thus, identification of sarcopenia could be important for fracture prevention as it may help improve fracture risk assessment, and muscle mass and strength can be improved with exercise, even among the frailest older adults. Unfortunately, there are no consensus diagnostic criteria for sarcopenia. Consequently there is no guidance to help clinicians identify older adults with clinically meaningful low muscle mass or weakness. Further, development of novel sarcopenia therapies is hindered not only due to the difficulty in identifying participants for clinical trials, and but also because there are no validated, clinically appropriate endpoints for assessment of treatment efficacy. There is currently a major push to establish a consensus definition of sarcopenia, and recent work holds promise that this goal may be within reach. This article discusses the evolution of the definition of sarcopenia, and focuses on the latest recommended diagnostic criteria proposed by the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. While these empirically‐based cut‐points for clinically important low muscle mass and weakness are a significant step forward for the sarcopenia field, important questions remain to be answered before consensus diagnostic criteria can be definitively established. Ongoing work to refine sarcopenia criteria will further advance the field and bring this important contributor to falls, fractures and disability into the mainstream of clinical care and ultimately lead to better quality of life with aging. © 2015 American Society for Bone and Mineral Research.  相似文献
9.

Background

The psoas muscle has been shown to predict patient outcomes based on the quantification of muscle area using computed tomography (CT) scans. The accuracy of morphomic analysis on other muscles has not been clearly delineated. In this study, we determine the correlation between temporalis muscle mass, psoas muscle area, age, body mass index (BMI), and gender.

Methods

Temporalis and psoas muscle dimensions were determined on all trauma patients who had both abdominal and maxillofacial CT scans at the University of Michigan between 2004 and 2011. Age, BMI, and gender were obtained through chart review. Univariate and multivariate analyses were performed to determine the relative relationship between morphomic data of the temporalis and psoas muscles and the ability of such information to correspond with clinical variables, such as BMI, age, and gender.

Results

A total of 646 patients were included in the present study. Among the 249 (38.5%) women and 397 (61.5%) men, the average age was 49.2 y. Average BMI was 27.9 kg/m². Total psoas muscle area directly correlated with mean temporalis muscle thickness (r = 0.57, P < 0.001). There was an indirect correlation between age and psoas muscle area (r = −0.52, P < 0.001) and temporalis muscle thickness (r = −0.36, P < 0.001). Neither psoas nor temporalis measurements correlated strongly with BMI (r = 0.18, P < 0.001; r = 0.14, P = 0.002), although stronger correlations were found in a more “frail,” subgroup as defined by a BMI of <20 (r = 0.59, P = 0.002).

Conclusions

We demonstrate that dimensions of the temporalis muscle can be quantified and may serve as a proxy for age. Going forward, we aim to assess the utility of temporalis and psoas morphomics in predicting complication rates among trauma patients admitted to the hospital to predict outcomes in the future.  相似文献
10.
雄激素对骨骼肌合成有明显影响,随着年龄增大,雄激素的下降常伴随肌量和肌力的下降。这种肌量和肌功能的下降,被称为少肌症或肌体老化,是老年人体质弱化(男性化减退)进展的关键事项。也是导致快速机能衰退及其不良后果的关键。雄激素水平下降对老年男性体质弱化(男性化减退)的潜在影响和对躯体功能的促进治疗作用无疑已经引起了相当的关注。本综述概述了近期关于肌肉老化、少肌症、老年体质弱化的概念、定义,并评估了关于雄激素和老年体质弱化的研究进展。近期源于观测性和介入性研究的证据强烈支持雄激素对老年男性肌量的作用,但雄激素对肌力和特有的躯体功能的效用并不明确。研究显示,雄激素治疗在老年男性中通常有良好的耐受性,而近期的研究则关注于雄激素的高剂量治疗和对于心血管风险较高人群的治疗。雄激素受体调节剂(SARMs)的初期试验研究显示传统雄激素治疗对于老年患者在肌量和肌功能方面有相同的效用。将来的重要研究方向包括利用这类雄激素治疗并结合适用于不同老年患者群体促进躯体功能的运动训练,同时将更多地关注近期关于激素水平、身体成分及躯体功能间关系的观测性(回顾性)研究。  相似文献
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