肌少症的CT、MR诊断及临床意义

肌少症(sarcopenia)于1997年被正式定义,是一种与年龄相关、全身广泛性复杂综合征,主要特征为骨骼肌量减少、肌力下降和功能减退。肌少症发病率随年龄增大而逐渐增高,明显降低老年人的生活质量,提高老年人群死亡率,给家庭及社会带来了极大的负面影响。近年来肌少症受到国内外学者越来越多的关注。肌量的评估是诊断肌少症的重要方面。双能X线及生物电阻抗可测量全身肌量,但是精确程度不高。CT与MR目前被认为是评估骨骼肌量的形态学金标准。CT、MR骨骼肌形态学相关研究,与骨质疏松及脆性骨折的发生有密切关系,可以对老年人及各种疾病患者的预后及生存率进行预测,并对身体成分及增肌训练的效果进行监测。临床在进行CT及MR检查,尤其是对老年人进行检查的同时应注意对肌少症的筛查与诊断。本文就肌少症的CT、MR诊断及其临床意义做一综述。     

肌肉质量测定方法的研究新进展

随着社会的快速发展,对人口老龄化引发的健康问题关注度越来越高。与衰老相伴随的肌少症亦慢慢走近了人们视野,以肌肉质量减少和/或肌肉力量下降或功能减退为其主要临床表现,严重影响老年人群的生活质量。因此,对肌少症的筛查与早期干预至关重要。肌肉质量评估是肌少症诊断与评估疗效必不可少的条件,双能X线骨密度仪（DXA）、计算机断层扫描（CT）、核磁共振成像（MRI）、生物电阻抗分析（BIA）等为临床肌肉质量常用的检测方法。除上述技术外,近来超声技术和D3-肌酸稀释法在肌肉质量评估中也展示不同视角。本文将对以上技术在肌肉质量检测中的研究进展进行系统综述。     

三种肌少症评估工具筛查社区老年人肌少症效果比较

目的 探讨适用于社区老年人肌少症筛查的工具,为早发现、早干预提供依据.方法 对山西省吕梁市13个县市城区社区的1455名老年人,分别采用肌肉减少症五条目(SARC-F)量表、肌肉减少症五条目联合小腿围(SARC-CalF)量表、肌肉减少症五条目结合老龄和体重指数(SARC-F+ EBM)量表进行测量,以2019年亚洲肌少症工作组肌少症诊断标准为依据,计算SARC-F、SARC-CalF、SARC-F+ EBM的敏感度、特异度、阳性预测值、阴性预测值及ROC曲线下面积(AUC).结果 社区老年人肌少症发病率为18.69％.SARC-F、SARC-CalF及SARC-F+EBM诊断敏感度分别为21.32％、66.67％、43.75％,特异度分别为86.19％、92.73％、87.24％,阳性预测值分别为25.89％、66.70％、44.07％,阴性预测值分别为82.62％、91.65％、87.09％,AUC分别为0.665、0.755、0.752.结论 SARC-CalF、SARC-F+ EBM比SARC-F具有更好的诊断性,可作为我国社区老年人肌少症的快速筛查工具.     

肿瘤病人的肌肉减少症及防治

正肌肉减少症(sarcopenia,简称肌少症)是一种以年龄相关的全身进行性广泛性骨骼肌肌量和肌力减少为特征的综合征~[1]。研究发现,在20岁之后的40~60年间,骨骼肌肌量下降可达40%~([2])。然而,年龄并不是导致肌肉减少症的唯一因素。恶性肿瘤、神经退行性疾病、内分泌紊乱、营养不良、肌肉废用、创伤等均可导致肌肉减少症的发生~([1])。肌肉减少症可致身体活动能力和平衡能力受损,进而引发     

绝经后女性肌少症

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。     

相位角在肌少症患者中的应用研究

相位角(phase angle, PA)是由生物电阻抗分析仪(bioelectrical impedance analysis, BIA)衍生出的一个重要指标,具有便捷、客观、无创等优点。临床研究发现PA可以预测肌少症。此外,中国老年人肌少症诊疗专家共识建议使用BIA来筛查和诊断社区和医院人群的肌少症。该文就目前PA在肌少症中的相关研究作一综述,为临床肌少症的筛查、评估和诊断提供参考。     

肌少症对老年患者脊柱手术预后影响的研究进展

肌少症(sarcopenia)或又称"肌肉减少症",由Rosen-berg首次提出[1].2010年欧洲老年人肌少症工作组(Eu-ropean Working Group on Sarcopenia in Older People,EWGSOP)将肌少症定义为:一种进行性、广泛性以肌力下降和肌量减少为特征的综合征,并伴...     

慢性肾脏病合并肌少症的研究进展

慢性肾脏病(chronic kidney disease, CKD)患者是罹患肌少症的高危人群, 但目前尚无CKD患者合并肌少症诊断的统一标准。基于国际上已发表的共识, 骨骼肌质量和功能是定义肌少症的关键参数, 近年来对于其评估工具的精准性和适用性的需求促进了高分辨成像测量以及超声测量的研究进展。目前我国大部分地区对CKD合并肌少症的认识不足, 临床漏诊、误诊现象普遍。该文综述了近年CKD合并肌少症的流行病学、评估方法以及防治的研究进展。     

东乡族成人低骨量与肌少症相关的肌肉质量下降的相关性研究

目的 分析甘肃省东乡族成人骨量与骨骼肌量变化规律,探讨骨量降低与肌少症相关的肌肉质量下降之间的关系。方法 对甘肃省东乡族432例(男性198例,女性234例)成人骨密度、骨强度及四肢骨骼肌量进行测量及数据分析,不同年龄段多组比较采用单因素方差分析,组间两两比较采用LSD法,相关性分析采用Pearson相关分析。结果 (1)东乡族成年男性骨强度指数及骨骼肌质量指数峰值出现在40～岁、女性出现在20～岁年龄组。(2)东乡族成人不同年龄段均出现低骨量与肌少症相关的肌肉质量下降情况。(3)骨量减少会导致骨强度指数及骨骼肌质量指数降低。(4)骨量异常情况下肌少症相关的肌肉质量下降明显。(5)骨量降低与年龄、骨强度指数、骨骼肌质量指数显著相关。结论 骨量减少与肌少症相关的肌肉质量下降显著相关,骨量异常是肌少症前期发生的一个危险因素。     

维持性血液透析患者营养不良-炎症综合征与肌少症的相关性

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.     

Dual Energy X-ray Absorptiometry and Bioimpedance Analysis are Clinically Useful for Measuring Muscle Mass in Kidney Transplant Recipients With Sarcopenia

Purpose

Computed tomography (CT) is considered the gold standard method for the diagnosis and characterization of sarcopenia. The aim of the present study was to determine the correlation between the volume of psoas muscle measured using CT and the measurement of muscle mass with dual energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA) in kidney transplant recipients.

Clinical Outcomes of Living Liver Transplantation According to the Presence of Sarcopenia as Defined by Skeletal Muscle Mass,Hand Grip,and Gait Speed

Background

Sarcopenia is an independent predictor of death after living-donor liver transplantation (LDLT). However, the ability of the Asian Working Group for Sarcopenia criteria for sarcopenia (defined as reduced skeletal muscle mass plus low muscle strength) to predict surgical outcomes in patients who have undergone LDLT has not been determined.

肌少症患者肌肉质量测评工具的研究进展

肌少症是肌肉质量和肌肉强度呈渐进性减少和下降的衰老综合征,可导致跌倒、骨折和失能等风险增高,对患者机体功能造成严重影响,极大降低了患者的生活质量,甚至导致死亡。为提高肌少症诊断和治疗效果,选择科学有效的测评工具十分重要。目前,各国际组织对肌少症的诊断标准仍未达成统一共识,尤其在肌肉质量测定部分存在较多争议。本文旨在通过复习总结相关国内外文献,阐述肌少症的筛查流程、诊断标准,重点探讨肌肉质量的测评工具及其优势与不足,以期为肌肉质量测评工具的选择及准确评估提供借鉴。     

腹部外科住院患者肌肉减少症状况及其影响因素分析

目的 了解腹部外科住院患者肌肉减少症的患病情况,分析其影响因素,为住院患者营养干预提供支持。方法 采用横断面研究,调查2019年12月至2021年7月山东省某三甲医院腹部外科符合入组标准的住院患者1 131例。记录患者一般资料,测定握力和6米步速时间,行人体成分分析和血清学指标测定,应用NRS2002量表进行营养风险筛查。根据亚洲肌肉减少症工作组（AWGS）2019诊断标准判定是否存在肌肉减少症,计算人群肌肉减少症患病率。将住院患者和其中的手术患者分为肌肉减少症组和非肌肉减少症组,比较住院患者的相关营养指标和手术患者的住院时间和术后住院时间,分析影响肌肉减少症的因素。结果 调查显示1 131例患者中肌肉减少症患者165例,患病率为14.59%;握力异常305例（26.97%）,四肢骨骼肌质量指数（ASMI）异常307例（27.14%）,步速异常272例（24.05%）。两组患者在体质量、体质指数、骨骼肌质量、去脂体质量、左上臂肌肉围度、相位角、白蛋白水平、血红蛋白水平、红细胞计数、淋巴细胞计数等方面比较,差异均有统计学意义（均P<0.05）。手术患者中肌肉减少症组的住院时间和术后...     

Sarcopenia and osteopenia among 70–80-year-old home-dwelling Finnish women: prevalence and association with functional performance

Summary

This study showed that the prevalence of sarcopenia (low muscle mass and performance) among 70–80-year-old home-dwelling Finnish women is very low, while every third woman has WHO-based osteopenia (low bone mass). Muscle mass and derived indices of sarcopenia were not significantly related to measures of functional ability.

Introduction

This study aims to determine the prevalence of sarcopenia and osteopenia among four hundred nine 70–80-year-old independently living Finnish women. The study compared consensus diagnostic criteria for age-related sarcopenia recently published by the European Working Group on Sarcopenia in Older People (EWGSOP) and the International Working Group on Sarcopenia (IWG) and assessed their associations with functional ability.

Methods

Femoral bone mineral density and body composition were measured with dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI), gait speed, and handgrip strength were used for sarcopenia diagnosis. Independent samples t tests determined group differences in body composition and functional ability according to recommended diagnostic cutpoints. Scatter plots were used to illustrate the correlations between the outcome measures used for diagnosis.

Results

Prevalence of sarcopenia was 0.9 and 2.7 % according to the EWGSOP and IWG, respectively. Thirty-six percent of the women had WHO-based osteopenia. Women with higher gait speed had significantly lower body weight and fat mass percentage, higher lean mass percentage, and better functional ability. Women with a low SMI weighed significantly less, with no significant differences in other outcome measures. SMI, gait speed, and grip strength were significantly correlated.

Conclusions

Our study suggests that when using consensus definitions, sarcopenia is infrequent among older home-dwelling women while every third woman has osteopenia. In clinical practice, attention should be paid to the decline in functional ability rather than focusing on low muscle mass alone.     

肌肉减少症病因学研究现状与展望

肌肉减少症是一种与年龄有关的肌肉力量下降和躯体功能受限的老年综合征,老年人出现跌倒、身体残疾、住院和早逝等不良后果风险增加。人均寿命延长导致老龄化,肌肉减少症的发病率和患病率明显升高。2016年国际卫生组织将其纳入《国际疾病分类第十次修订版:临床修改》(ICD-10-CM),疾病编码为M62.84。目前肌肉减少症最常用的定义是欧洲老年人肌肉减少症工作组(EWGSOP)提出的,表示与增龄相关的进行性的全身肌肉量减少、肌肉强度下降或肌肉生理功能减退,2019年EWGSOP更新肌肉减少症定义。肌肉减少症被认为是晚年负面健康结果的相关决定因素,肌肉力量和活动能力的丧失导致躯体平衡障碍,老年人发生跌倒和骨折的比率升高,增加社会残疾率及医疗负担,明确病因十分重要。近年来国内外学者研究发现肌肉减少症与运动因素、内分泌因素、慢性炎症、营养状况、肠道菌群、遗传因素及社会心理素等相关,但具体病因尚不明确。本文通过查阅大量有关文献,对肌肉减少症病因学研究现状与进展作一综述。     

Sarcopenia Definitions as Predictors of Fracture Risk Independent of FRAX®, Falls,and BMD in the Osteoporotic Fractures in Men (MrOS) Study: A Meta-Analysis

Dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass/height² (ALM/ht²) is the most commonly used estimate of muscle mass in the assessment of sarcopenia, but its predictive value for fracture is substantially attenuated by femoral neck (fn) bone mineral density (BMD). We investigated predictive value of 11 sarcopenia definitions for incident fracture, independent of fnBMD, fracture risk assessment tool (FRAX^®) probability, and prior falls, using an extension of Poisson regression in US, Sweden, and Hong Kong Osteoporois Fractures in Men Study (MrOS) cohorts. Definitions tested were those of Baumgartner and Delmonico (ALM/ht² only), Morley, the International Working Group on Sarcopenia, European Working Group on Sarcopenia in Older People (EWGSOP1 and 2), Asian Working Group on Sarcopenia, Foundation for the National Institutes of Health (FNIH) 1 and 2 (using ALM/body mass index [BMI], incorporating muscle strength and/or physical performance measures plus ALM/ht²), and Sarcopenia Definitions and Outcomes Consortium (gait speed and grip strength). Associations were adjusted for age and time since baseline and reported as hazard ratio (HR) for first incident fracture, here major osteoporotic fracture (MOF; clinical vertebral, hip, distal forearm, proximal humerus). Further analyses adjusted additionally for FRAX-MOF probability (n = 7531; calculated ± fnBMD), prior falls (y/n), or fnBMD T-score. Results were synthesized by meta-analysis. In 5660 men in USA, 2764 Sweden and 1987 Hong Kong (mean ages 73.5, 75.4, and 72.4 years, respectively), sarcopenia prevalence ranged from 0.5% to 35%. Sarcopenia status, by all definitions except those of FNIH, was associated with incident MOF (HR = 1.39 to 2.07). Associations were robust to adjustment for prior falls or FRAX probability (without fnBMD); adjustment for fnBMD T-score attenuated associations. EWGSOP2 severe sarcopenia (incorporating chair stand time, gait speed, and grip strength plus ALM) was most predictive, albeit at low prevalence, and appeared only modestly influenced by inclusion of fnBMD. In conclusion, the predictive value for fracture of sarcopenia definitions based on ALM is reduced by adjustment for fnBMD but strengthened by additional inclusion of physical performance measures. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).