肌少症的诊治新进展

doi:10.3877/cma.j.issn.2095-8757.2021.02.007

老年肌少症是一种随增龄而逐渐丧失肌肉并导致肌力和运动功能下降的疾病。越来越多的研究表明，肌少症是导致老年人出现不良结果的主要危险因素。因此，早期识别诊断并及时给予有效干预是维持老年人机体功能、减少或者推迟负面健康相关事件、保障老年人生活质量的关键。本文回顾近十多年来关于肌少症的相关文献，重点综述其诊断和治疗的新进展，以期为临床进一步了解肌少症并早期诊断及实施个体化综合治疗提供帮助。

关键词: 肌少症, 诊断, 治疗

Sarcopenia is a disease with the gradual loss of muscle and resulting in decreased muscle strength and motor function. More and more studies have shown that sarcopenia is a major risk factor for adverse outcomes in the elderly. Therefore, early identification and diagnosis and timely effective interventions are the key to maintain the body function, reducing or postponing negative health-related events, and ensure the quality of life of the elderly. This article reviews the relevant literature on sarcopenia in the past decade and focuses on the new progress in diagnosis and treatment of sarcopenia, in order to provide help for further understanding and early diagnosis and implementation of individualized comprehensive treatment of sarcopenia.

Key words: Sarcopenia, Diagnosis, Treatment

图1 2018年欧洲老年人肌少症工作组肌少症评估流程图

表1 不同标准按性别划分的肌少症操作性定义概述

不同标准	肌肉质量（kg/m²）	握力	运动功能
欧洲老年人肌少症工作组（2010）	DXA-SMI：男<7.26，女<5.50；	男<30 kg，女<20 kg	步速<1 m/s
	BIA-SMI：男<8.87，女<6.42		步速<1 m/s
国际肌少症工作组（2011）	DXA-SMI：男<7.23，女<5.67	—
亚洲肌减少症工作组（2014）	DXA-SMI：男<7.0，女<5.4；	男<26 kg，女<18 kg	步速<0.8 m/s
	BIA-SMI：男<7.0，女<5.7
美国国立卫生研究院基金会（2014）	ALM_BMI：男<0.789，女<0.512	男<26 kg，女<16 kg	—
欧洲老年人肌少症工作组（2018）	ALM：男<19.75，女<15.02；	男<27 kg，女<16 kg	步速<0.8 m/s或SPPB≤8分或TUG≥20 s或400 m步行未完成或需≥6 min或站起试验5次>15 s
	ASM：男<20，女<15；
	DXA-SMI：男<7.0，女<6.0
亚洲肌减少症工作组（2019）	DXA-SMI：男<7.0，女<5.4；	男<28 kg，女<18 kg	步速<1.0 m/s或SPPB≤9分或站起试验5次>12 s
	BIA-SMI：男<7.0，女<5.7		步速<1.0 m/s或SPPB≤9分或站起试验5次>12 s

表1 不同标准按性别划分的肌少症操作性定义概述

不同标准	肌肉质量（kg/m²）	握力	运动功能
欧洲老年人肌少症工作组（2010）	DXA-SMI：男<7.26，女<5.50；	男<30 kg，女<20 kg	步速<1 m/s
	BIA-SMI：男<8.87，女<6.42		步速<1 m/s
国际肌少症工作组（2011）	DXA-SMI：男<7.23，女<5.67	—
亚洲肌减少症工作组（2014）	DXA-SMI：男<7.0，女<5.4；	男<26 kg，女<18 kg	步速<0.8 m/s
	BIA-SMI：男<7.0，女<5.7
美国国立卫生研究院基金会（2014）	ALM_BMI：男<0.789，女<0.512	男<26 kg，女<16 kg	—
欧洲老年人肌少症工作组（2018）	ALM：男<19.75，女<15.02；	男<27 kg，女<16 kg	步速<0.8 m/s或SPPB≤8分或TUG≥20 s或400 m步行未完成或需≥6 min或站起试验5次>15 s
	ASM：男<20，女<15；
	DXA-SMI：男<7.0，女<6.0
亚洲肌减少症工作组（2019）	DXA-SMI：男<7.0，女<5.4；	男<28 kg，女<18 kg	步速<1.0 m/s或SPPB≤9分或站起试验5次>12 s
	BIA-SMI：男<7.0，女<5.7		步速<1.0 m/s或SPPB≤9分或站起试验5次>12 s

表2 可用于临床和科研的肌少症病例筛查、肌量和体能测量的诊断工具

不同需求	适用于临床	适用于科研
病例筛查	SARC-F问卷；Ishii筛查工具	SARC-F
肌力测试	握力；站起试验(坐-立5次)	站起实验(坐-立5次)
肌量和肌质评估	DXA评估四肢肌量；BIA评估全身肌量或四肢肌量；CT或MRI检测计算腰椎横截面积	DXA评估四肢肌量；MRI评估全身肌量或四肢肌量；通过活检、CT、MRI或MRS评估大腿中部或全身肌量
身体功能评估	步速；SPPB；TUG；400 m步行	步速；SPPB；TUG；400 m步行

表2 可用于临床和科研的肌少症病例筛查、肌量和体能测量的诊断工具

不同需求	适用于临床	适用于科研
病例筛查	SARC-F问卷；Ishii筛查工具	SARC-F
肌力测试	握力；站起试验(坐-立5次)	站起实验(坐-立5次)
肌量和肌质评估	DXA评估四肢肌量；BIA评估全身肌量或四肢肌量；CT或MRI检测计算腰椎横截面积	DXA评估四肢肌量；MRI评估全身肌量或四肢肌量；通过活检、CT、MRI或MRS评估大腿中部或全身肌量
身体功能评估	步速；SPPB；TUG；400 m步行	步速；SPPB；TUG；400 m步行

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New progress in diagnosis and treatment of sarcopenia

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New progress in diagnosis and treatment of sarcopenia