老年慢性阻塞性肺疾病合并肌少症诊断工具的研究进展

肌少症是一种老年综合征,在过去的十年中,人们对它的认识逐步提高。它作为慢性阻塞性肺疾病(COPD)多种常见合并症之一,能加速疾病进程,增加跌倒风险、住院率、病死率。目前我国已步入老龄社会,肌少症在临床实践中经常诊断不足,本文对肌少症合并COPD患者在不同的环境中选择经济、方便、准确的检测工具进行综述,以期为临床决策提供...     

老年2型糖尿病并发肌少症的相关研究及降糖药物选择

随着预期寿命增加,衰老过程中出现的肌肉无力逐渐引起关注。作为老年人口主要的健康负担的糖尿病,其神经血管并发症只能部分解释病人日渐出现的肌肉无力、耐力下降、活动障碍及身体残疾等表现,肌少症的提出进一步解释了这种身体机能的减退。该文对老年糖尿病病人并发肌少症的发病机制、危险因素进行归纳总结,突出强调对于肌少症的早期预防以及各类降糖药物对于骨骼肌的影响,为降糖药物选择提供新思路。     

Low thoracic muscle mass index on computed tomography predicts adverse outcomes following lobectomy via thoracotomy for lung cancer

 Open in a separate windowOBJECTIVESThe aim of this study was to determine whether the preoperative thoracic muscle mass is associated with postoperative outcomes in patients undergoing lobectomy via thoracotomy for lung cancer.METHODSConsecutive patients undergoing lobectomy were retrospectively reviewed. The thoracic muscle mass index (TMMI) was obtained at the level of the fifth thoracic vertebra on preoperative thoracic computed tomography (CT). Patients were analysed comparatively by being dividing into low and high muscle index groups by the median of sex-specific TMMI. The primary outcomes were the incidence of any or postoperative pulmonary complications. The secondary outcomes were postoperative intensive care unit (ICU) admission, length of stay (LOS) in the ICU, total hospital LOS, readmission and mortality.RESULTSThe study population consisted of 120 patients (63.6 ± 9.8 years; 74% male). Each groups included 60 patients. Major complications occurred in 28.3% (34/120) and readmission in 18.3% (22/120) of patients. The adjusted multivariable analysis showed that each unit increase in TMMI (cm²/m²) was independently associated with the rates of less any complications [odds ratio (OR) 0.92, P = 0.014], pulmonary complications (OR 0.27, P = 0.019), ICU admission (OR 0.76, P = 0.031), hospitalization for >6 days (OR 0.90, P = 0.008) and readmission (OR 0.93, P = 0.029).CONCLUSIONSLow TMMI obtained from the preoperative thoracic CT is an independent predictor of postoperative adverse outcomes in patients following lobectomy via thoracotomy for lung cancer. TMMI measurements may contribute to the development of preoperative risk stratification studies in the future.     

Nutritional issues in patients with obesity and cirrhosis

Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to cirrhosis.Patients with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver cirrhosis.Sarcopenic obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronicliver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver transplantation.Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble,water-soluble vitamins and trace elements and should be supplemented appropriately.Diet,physical activity and protein intake should be carefully monitored in these fragile patients according to recent recommendations.Bariatric surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver transplantation.The risk of sarcopenia,micronutrient status,and the recommended supplementation in patients with obesity and cirrhosis are discussed in this review.Furthermore,the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.     

Gut microbiota in common elderly diseases affecting activities of daily living

Gut microbiota are involved in the development or prevention of various diseases such as type 2 diabetes,fatty liver, and malignancy such as colorectal cancer,breast cancer and hepatocellular carcinoma. Alzheimer'sdisease, osteoporosis, sarcopenia, atherosclerotic stroke and cardiovascular disease are major diseases associated with decreased activities of daily living(ADL), especially in elderly people. Recent analyses have revealed the importance of gut microbiota in the control of these diseases. The composition or diversity of these microbiota is different between patients with these conditions and healthy controls, and administration of probiotics or prebiotics has been shown effective in the treatment of these diseases. Gut microbiota may affect distant organs through mechanisms that include regulating the absorption of nutrients and/or the production of microbial metabolites, regulating and interacting with the systemic immune system, and translocating bacteria/bacterial products through disrupted mucosal barriers.Thus, the gut microbiota may be important regulators in the development of diseases that affect ADL. Although adequate exercise and proper diet are important for preventing these diseases, their combination with interventions that manipulate the composition and/or diversity of gut microbiota could be a promising strategy for maintaining health condition and preserving ADL. This review thus summarizes current understanding of the role of gut microbiota in the development or prevention of diseases closely associated with the maintenance of ADL.     

营养与肌肉减少症

肌肉减少症是一组与年龄相关的骨骼肌质量和力量的进行性和普遍性减少和丧失的综合征。肌肉减少症在老年人 群中非常普遍,约有10% 的60 岁以上老年人患有该综合征。患肌肉减少症的老年人发生失能、生活质量降低和死亡等临床 不良事件的风险大大增加。营养不良也是老年人群常见问题。虽然营养状态正常的老年人也会罹患肌肉减少症,但研究发现 营养不良的老年人其患病风险会进一步增高。此外,缺乏某些特殊的微量营养元素也被发现与肌肉减少症的患病有关。鉴于 肌肉减少症给老年人结局带来的不良影响,越来越多的研究开始探索肌肉减少症的有效干预手段。目前,针对肌肉减少症的 干预措施主要从病因方面入手,包括运动干预、营养干预、激素补充以及药物干预等,其中营养干预成为了近年来研究的热点。 肌肉减少症的营养干预的方案多种多样,包括蛋白质、氨基酸、肌酸、维生素D、矿物质元素、不饱和脂肪酸等。本文将 就不同营养元素对肌肉减少症干预的有效性进行介绍,并基于目前证据提出肌肉减少症营养干预的相关建议。     

Sarcopenia is associated with incident albuminuria in patients with type 2 diabetes: A retrospective observational study

Sarcopenia, defined as age‐related loss of skeletal muscle mass and function, increases the risk of albuminuria. However, it has still unknown whether sarcopenia could increase the risk for the progression of albuminuria. A total 238 patients with type 2 diabetes (mean age 64 ± 12 years; 39.2% women) were studied in the present retrospective observational study. The prevalence of sarcopenia was 17.6%. During the median follow‐up period of 2.6 years, albuminuria was measured 5.8 ± 1.8 times, and progression of albuminuria was observed in 14.9% of patients with normoalbuminuria, as was 11.5% in those with microalbuminuria. Sarcopenia was significantly associated with both progression (hazard ratio 2.61, 95% confidence interval 1.08–6.31, P = 0.034) and regression (hazard ratio 0.23, 95% confidence interval 0.05–0.98, P = 0.048) of albuminuria by multivariate Cox regression analysis. The present data suggest that sarcopenia is an important determinant of both progression and regression of albuminuria in patients with type 2 diabetes.     

少肌性肥胖对肿瘤患者临床结局的影响

近年来,身体组分和肿瘤患者临床结局之间的关系越来越受到关注,身体组分相关术语（如肌肉减少症,肥胖, 少肌性肥胖等）也逐渐被大家接受并得到广泛应用。少肌性肥胖定义为肌肉减少症（瘦体组织减少）和肥胖（脂肪组织增加）同时存在。现有临床研究表明少肌性肥胖和肿瘤患者的发生、发展和预后密切相关,及早干预可以改善肿瘤患者的临床结局。 但目前国内外的研究尚少且认识有限。为了增加对肿瘤患者少肌性肥胖的认识从而更好的指导临床工作。本文综合了国内 外关于少肌性肥胖和肿瘤患者不良临床结局关系的研究进展,对具有少肌性肥胖的肿瘤患者的诊断,发生现状以及和临床结局的相关性进行了综述及分析。表明少肌性肥胖的肿瘤患者具有更高的剂量限制毒性、术后并发症率及更差的总生存。少肌性肥胖应受到大家的重视。     

Sarcopenia and liver transplant: The relevance of too little muscle mass

Loss of muscle mass and function is a common occurrence in both patients with decompensated cirrhosis and those undergoing liver transplantation. Sarcopenia is associated with morbidity and mortality before and after liver transplantation. The ability of skeletal muscle mass to recover after transplant isquestionable, and long term adverse events associated with persistent sarcopenia have not been well studied. Limited data is available examining mechanisms by which decreased muscle mass might develop. It is not clear which interventions might reduce the prevalence of sarcopenia and associated health burdens. However, measures to either decrease portal hypertension or improve nutrition appear to have benefit. Research on sarcopenia in the liver transplant setting is hampered by differing methodology to quantify muscle mass and varied thresholds determining the presence of sarcopenia. One area highlighted in this review is the heterogeneity used when defining sarcopenia. The health consequences, clinical course and potential pathophysiologic mechanisms of sarcopenia in the setting of cirrhosis and liver transplantation are further discussed.     

Physiopathological mechanism of sarcopenia

The etiology of sarcopenia is multifactorial but still poorly understood, and the sequelae of this phenomenon represent a major public health issue. Age-related loss of muscle mass can be counteracted by adequate metabolic interventions including nutritional intake and exercise training. Other strategies including changes in daily protein pattern, the speed of protein digestion, or specific amino acid supplementation may be beneficial to improve short-term muscle anabolic response in elderly people. A multimodal approach combining nutrition, exercise, hormones, and specific anabolic drugs may be an innovative treatment for limiting the development of sarcopenia with aging.