肌少症患者生存质量评估工具的研究进展

肌少症是以全身肌肉进行性损失增高和机体功能下降为特点的老年综合征，可增加患者失能、骨折和跌倒等风险，严重危害患者的生存质量。目前，我国对于肌少症的研究处于起步阶段，研究重心多倾向于发病机制、诊断评估及康复治疗等方面，生存质量尚未引起广泛重视。该文对肌少症患者生存质量的评估工具、影响因素及未来研究启示进行综述，旨在为肌少症患者生存质量评估工具的本土化发展，临床实践选择合适的评估工具并深入开展相关领域的研究提供依据。     

5种肌少症评估工具筛查维持性血液透析患者肌少症效果比较

目的 比较5种肌少症评估工具在维持性血液透析人群中的诊断效能，为早期筛查肌少症风险提供可行性评估工具。 方法 选取130例维持性血液透析患者为研究对象，分别使用简易5项评分量表（SARC-F）、SARC-CalF评分量表、Ishii评分和中文版迷你肌少症风险评估量表（包括7条目量表和5条目量表）对其进行筛查。分别采用老年人肌少症欧洲工作组、亚洲肌少症工作组、美国国立卫生研究院基金会和肌少症国际工作组制定的标准作为诊断标准，计算5种评估工具的的灵敏度、特异度、约登指数及受试者操作特征曲线下面积。 结果 采用前3种标准时，Ishii评分的受试者操作特征曲线下面积分别为0.793、0.871和0.752，在同类标准下最大；采用肌少症国际工作组标准时，SARC-CalF评分的受试者操作特征曲线下面积为0.739，同类中最大。 结论 5种肌少症评估工具中，Ishii评分是筛查维持性血液透析患者肌少症风险的首优选择，其次推荐SARC-CalF评分。     

肌少症的定量测量现状及研究进展

肌少症是一种以骨骼肌质量减少及其功能减退为主要临床表现的复杂的老年综合征。在全球其发病率逐年增高,目前已成为威胁老年人健康,影响老年人生活质量的重要危险因素。其诊断标准主要由欧洲老年人肌少症工作组、亚洲肌少症工作组、国际肌少症会议工作组提出的,通过骨骼肌质量、肌肉力量和身体活动能力进行诊断。肌少症前期仅有肌肉质量减少,肌少症期包括肌肉质量减少伴随肌肉力量下降或身体活动能力降低,重度肌少症期肌肉质量以及身体活动能力均会降低。早期对骨骼肌进行定量测量成为诊断肌少症的重要手段之一。骨骼肌定量测量方法主要有计算机X线体层摄影、磁共振成像、双能X线吸收法、生物电阻抗测量、超声等方法。计算机体X线层摄影在骨骼肌质量的研究中主要应用是作为金标准来校准其他方法;磁共振成像在肌肉定量测量中发挥着越来越重要的作用;双能X线吸收测定法和生物电阻抗方法是目前公认筛查肌少症的手段,并且有诊断的阈值,然而精确性欠佳;超声有经济、易携带、高效等优点,但其对体成分的检测价值有限。本文探讨了骨骼肌定量测量研究的现状及其进展。     

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。     

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.     

慢性肾脏病患者肌少症的诊治进展

慢性肾脏病(chronic kidney disease,CKD)患者中肌少症的患病率高,肌少症与CKD患者生存质量和预后密切相关。2010年,欧洲老年肌少症工作组首次提出了肌少症的定义。2018年,该工作组基于循证医学证据更新了肌少症的定义及临床诊断方法。目前我国对肌少症认识不足,因此,加强宣教、提高早期识别能力并及时干预治疗,对降低肌少症的发生率、改善患者的预后有重要价值。本文对CKD肌少症的诊断标准和方法以及防治进展进行综述。     

老年肌少症护理评估的研究进展

介绍肌少症的诊断依据,从肌量、肌力、肌肉功能和风险评估方面综述肌少症的护理评估方法,并对老年肌少症的护理评估提出建议,旨在为开展老年肌少症护理评估及筛查提供参考。     

肌肉减少症对传统腰椎后路开放手术治疗腰椎管狭窄症临床疗效的影响北大核心CSCD

目的 探究肌肉减少症(简称肌少症)对传统腰椎后路开放手术治疗腰椎管狭窄症患者临床疗效的影响。方法 回顾分析2017年8月—2020年12月符合选择标准的50例腰椎管狭窄症患者临床资料,依据欧洲老年人肌少症工作组(EWGSOP)的诊断标准,基于计算L3水平骨骼肌指数(skeletal muscle index,SMI),以SMI<45.4 cm^(2)/m^(2)(男性)和SMI>34.4 cm^(2)/m^(2)(女性)作为诊断阈值分为肌少症组(25例)和非肌少症组(25例)。两组患者性别、年龄、病程、腰椎管狭窄节段、手术融合节段、合并症等一般资料比较差异均无统计学意义(P>0.05);肌少症组患者身体质量指数明显低于非肌少症组,差异有统计学意义(t=-3.198,P=0.002)。记录并比较两组患者手术时间、术中出血量、术后引流量、住院时间、并发症,术前及末次随访时腰痛和坐骨神经痛疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI);采用改良MacNab评定标准评价手术疗效。结果 两组手术时间、术中出血量及术后引流量比较差异无统计学意义(P>0.05);肌少症组住院时间显著长于非肌少症组(t=2.105,P=0.044)。两组患者均获随访,随访时间7~36个月,平均29.7个月。肌少症组术中出现硬膜撕裂及脑脊液漏1例、随访期间内固定物松动1例,两组各发生1例切口渗液、愈合不良,随访期间两组均未发生邻近节段退变及下肢深静脉血栓形成;两组并发症发生率(12%vs.4%)比较差异无统计学意义(χ^(2)=1.333,P=0.513)。末次随访时,两组患者腰痛及坐骨神经痛VAS评分和ODI评分均较术前显著改善(P<0.05)。肌少症组患者腰痛VAS评分及ODI评分手术前后差值显著低于非肌少症组(P<0.05),两组坐骨神经痛VAS评分手术前后差值比较差异无统计学意义(t=-1.494,P=0.144)。按照改良MacNab评定标准评价疗效,肌少症组优良率为92%,非肌少症组优良率为96%,两组差异无统计学意义(χ^(2)=1.201,P=0.753)。结论 与非肌少症患者相比,肌少症合并腰椎管狭窄症患者术后康复时间可能更长,手术临床疗效更差。肌少症需引起脊柱外科医生关注,可通过早期筛查发现有手术预后不良风险的肌少症患者,从而在围术期进行康复指导和营养干预。     

胃癌合并肌少症的研究进展

肌少症是与年龄相关、由骨骼肌质量和功能丧失引起的临床综合征,主要诱因包括运动缺乏、神经肌肉功能减弱、增龄相关激素变化以及炎性细胞因子水平升高等。胃癌是我国最常见的消化道肿瘤之一,其发病率和病死率在癌症中分别位居第二、三位,严重威胁人们的健康。多项研究表明,胃癌合并肌少症可显著影响患者的术后状态及生存期,在预测胃癌预后方面有重要意义。并且,治疗胃癌的部分药物以及化疗会导致化疗相关性肌少症,对胃癌患者治疗的结局产生负面影响。近年来,肌少症对胃癌的影响日益受到关注。笔者就肌少症发病机制、化疗相关性肌少症、肌少症预测胃癌预后的意义、胃癌合并肌少症治疗和预防予以综述,以期为胃癌患者精准治疗方案的制定提供新的思路。     

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。     

Developing Consensus Criteria for Sarcopenia: An Update

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.     

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.     

Is sarcopenia a missed factor in the management of patients with metastatic breast cancer?

BackgroundSarcopenia has emerged as an important parameter to predict outcomes and treatment toxicity. However, limited data are available to assess sarcopenia prevalence in metastatic breast cancer and to evaluate its management.MethodsThe SCAN study was a cross-sectional multicenter French study that aimed to estimate sarcopenia prevalence in a real-life sample of metastatic cancer patients. Sarcopenia was identified by low muscle mass (estimated from the skeletal muscle index at the third lumbar, via computed tomography) and low muscle strength (defined by handgrip strength). Three populations were distinguished based on EWGSOP criteria: a sarcopenic group with low muscle mass AND strength, a pre-sarcopenic group with low muscle mass OR strength and a normal group with high muscle mass AND strength.ResultsAmong 766 included patients, 139 patients with breast cancer and median age of 61.2 years (29.9–97.8 years) were evaluable; 29.5% were sarcopenic and 41.0% were pre-sarcopenic. Sarcopenic patients were older (P < 0.01), had a worse PS-score (P < 0.05), and a higher number of metastatic sites (P < 0.01), the majority being hepatic and bone. A moderate agreement between the oncologist's diagnosis and sarcopenia evaluation by muscle mass and strength was recognized (Cohen's kappa = 0.45). No associations were found between sarcopenia and adverse event occurrence in the 12 patients for whom these were reported. Sarcopenic patients were underdiagnosed and nutritional care and physical activity were less proposed.ConclusionIt is necessary to evaluate sarcopenia due to its impact on patient prognosis, and its utility in guiding patient management in metastatic breast cancer.     

肌肉减少症患者的围术期麻醉管理

肌肉减少症作为老年疾病中的一种,并未引起临床的广泛关注。肌肉减少症常伴发其他疾病发生,影响患者的康复以及术后转归。麻醉科医师应该重视肌肉减少症患者的围术期管理。本文对肌肉减少症的现状、麻醉对骨骼肌的影响以及围术期麻醉管理的要点进行综述,希望引起麻醉科医师的关注。     

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.

The Update on Instruments Used for Evaluation of Comorbidities in Total Hip Arthroplasty

IntroductionIt is a well-established fact that concomitant diseases can affect the outcome of total hip arthroplasty (THA). Therefore, careful preoperative assessment of a patient''s comorbidity burden is a necessity, and it should be a part of routine screening as THA is associated with a significant number of complications. To measure the multimorbidity, dedicated clinical tools are used.MethodsThe article is a systematic review of instruments used to evaluate comorbidities in THA studies. To create a list of available instruments for assessing patient''s comorbidities, the search of medical databases (PubMed, Web of Science, Embase) for indices with proven impact on revision risk, adverse events, mortality, or patient''s physical functioning was performed by two independent researchers.ResultsThe initial search led to identifying 564 articles from which 26 were included in this review. The measurement tools used were: The Charlson Comorbidity Index (18/26), Society of Anesthesiology classification (10/26), Elixhauser Comorbidity Method (6/26), and modified Frailty Index (5/26). The following outcomes were measured: quality of life and physical function (8/26), complications (10/26), mortality (8/26), length of stay (6/26), readmission (5/26), reoperation (2/26), satisfaction (2/26), blood transfusion (2/26), surgery delay or cancelation (1/26), cost of care (1/26), risk of falls (1/26), and use of painkillers (1/26). Further research resulted in a comprehensive list of eleven indices suitable for use in THA outcomes studies.ConclusionThe comorbidity assessment tools used in THA studies present a high heterogeneity level, and there is no particular system that has been uniformly adopted. This review can serve as a help and an essential guide for researchers in the field.     

Diagnostic measures for sarcopenia and bone mineral density

Summary

Currently used diagnostic measures for sarcopenia utilize different measures of muscle mass, muscle strength, and physical performance. These diagnostic measures associate differently to bone mineral density (BMD), as an example of muscle-related clinical outcome. These differences should be taken into account when studying sarcopenia.

Introduction

Diagnostic measures for sarcopenia utilize different measures of muscle mass, muscle strength, and physical performance. To understand differences between these measures, we determined the association with respect to whole body BMD, as an example of muscle-related clinical outcome.

Methods

In the European cross-sectional study MYOAGE, 178 young (18–30 years) and 274 healthy old participants (69–81 years) were recruited. Body composition and BMD were evaluated using dual-energy X-ray densitometry. Diagnostic measures for sarcopenia were composed of lean mass as percentage of body mass, appendicular lean mass (ALM) as percentage of body mass, ALM divided by height squared (ALM/height²), knee extension torque, grip strength, walking speed, and Timed Up and Go test (TUG). Linear regression models were stratified for sex and age and adjusted for age and country, and body composition in separate models.

Results

Lean mass and ALM/height² were positively associated with BMD (P?<?0.001). Significance remained in all sex and age subgroups after further adjustment for fat mass, except in old women. Lean mass percentage and ALM percentage were inversely associated with BMD in old women (P?<?0.001). These inverse associations disappeared after adjustment for body mass. Knee extension torque and handgrip strength were positively associated with BMD in all subgroups (P?<?0.01), except in old women. Walking speed and TUG were not related to BMD.

Conclusions

The associations between diagnostic measures of sarcopenia and BMD as an example of muscle-related outcome vary widely. Differences between diagnostic measures should be taken into account when studying sarcopenia.