JCSM clinical reports最新文献_第6页

The Role of Systemic Inflammation in Cancer-Associated Muscle Wasting and Rationale for Exercise as a Therapeutic Intervention 系统性炎症在癌症相关肌肉萎缩中的作用以及运动作为治疗干预的基本原理

JCSM clinical reports

Pub Date : 2018-07-01 DOI: 10.17987/jcsm-cr.v3i2.65

Calvin L. Cole, Ian R. Kleckner, Aminah Jatoi, Edward M. Schwarz, Richard F. Dunne

Progressive skeletal muscle wasting in cancer cachexia involves a process of dysregulated protein synthesis and breakdown. This catabolism may be the result of mal-nutrition, and an upregulation of both pro-inflammatory cytokines and the ubiquitin proteasome pathway (UPP), which can subsequently increase myostatin and activin A release. The skeletal muscle wasting associated with cancer cachexia is clinically significant, it can contribute to treatment toxicity or the premature discontinuation of treatments resulting in increases in morbidity and mortality. Thus, there is a need for further investigation into the pathophysiology of muscle wasting in cancer cachexia to develop effective prophylactic and therapeutic interventions. Several studies have identified a central role for chronic-systemic inflammation in initiating and perpetuating muscle wasting in patients with cancer. Interestingly, while exercise has shown efficacy in improving muscle quality, only recently have investigators begun to assess the impact that exercise has on chronic-systemic inflammation. To put this new information into context with established paradigms, here we review several biological pathways (e.g. dysfunctional inflammatory response, hypothalamus pituitary adrenal axis, and increased myostatin/activin A activity) that may be responsible for the muscle wasting in patients with cancer. Additionally, we discuss the potential impact that exercise has on these pathways in the treatment of cancer-related muscle wasting. Exercise is an attractive intervention for muscle wasting in this population, partially because it disrupts chronic-systemic inflammation mediated catabolism. Most importantly, exercise is a potent stimulator of muscle synthesis, and therefore this therapy may reverse muscle damage caused by cancer cachexia.

癌症恶病质的进行性骨骼肌萎缩涉及一个蛋白质合成和分解失调的过程。这种分解代谢可能是营养不良、促炎细胞因子和泛素蛋白酶体途径(UPP)上调的结果，UPP随后会增加肌肉生长抑制素和激活素A的释放。与癌症恶病质相关的骨骼肌萎缩具有重要的临床意义，它可能导致治疗毒性或过早停止治疗，导致发病率和死亡率增加。因此，有必要进一步研究癌症恶病质中肌肉萎缩的病理生理机制，以制定有效的预防和治疗措施。几项研究已经确定了慢性全身性炎症在癌症患者肌肉萎缩的启动和延续中所起的核心作用。有趣的是，虽然运动显示出改善肌肉质量的功效，但直到最近，研究人员才开始评估运动对慢性全身性炎症的影响。为了将这些新信息与已建立的范式结合起来，我们回顾了几种可能导致癌症患者肌肉萎缩的生物学途径(如功能失调的炎症反应、下丘脑垂体肾上腺轴和肌肉生长抑制素/激活素A活性增加)。此外，我们还讨论了运动在治疗癌症相关肌肉萎缩过程中对这些途径的潜在影响。在这一人群中，运动是一种有吸引力的肌肉萎缩干预措施，部分原因是它破坏了慢性全身炎症介导的分解代谢。最重要的是，运动是肌肉合成的有力刺激物，因此这种疗法可以逆转由癌症恶病质引起的肌肉损伤。

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引用次数: 48

The Role of Systemic Inflammation in Cancer-Associated Muscle Wasting and Rationale for Exercise as a Therapeutic Intervention. 系统性炎症在癌症相关肌肉萎缩中的作用以及运动作为治疗干预的基本原理。

JCSM clinical reports

Pub Date : 2018-07-01

Calvin L Cole, Ian R Kleckner, Aminah Jatoi, Edward M Schwarz, Richard F Dunne

Progressive skeletal muscle wasting in cancer cachexia involves a process of dysregulated protein synthesis and breakdown. This catabolism may be the result of mal-nutrition, and an upregulation of both pro-inflammatory cytokines and the ubiquitin proteasome pathway (UPP), which can subsequently increase myostatin and activin A release. The skeletal muscle wasting associated with cancer cachexia is clinically significant, it can contribute to treatment toxicity or the premature discontinuation of treatments resulting in increases in morbidity and mortality. Thus, there is a need for further investigation into the pathophysiology of muscle wasting in cancer cachexia to develop effective prophylactic and therapeutic interventions. Several studies have identified a central role for chronic-systemic inflammation in initiating and perpetuating muscle wasting in patients with cancer. Interestingly, while exercise has shown efficacy in improving muscle quality, only recently have investigators begun to assess the impact that exercise has on chronic-systemic inflammation. To put this new information into context with established paradigms, here we review several biological pathways (e.g. dysfunctional inflammatory response, hypothalamus pituitary adrenal axis, and increased myostatin/activin A activity) that may be responsible for the muscle wasting in patients with cancer. Additionally, we discuss the potential impact that exercise has on these pathways in the treatment of cancer-related muscle wasting. Exercise is an attractive intervention for muscle wasting in this population, partially because it disrupts chronic-systemic inflammation mediated catabolism. Most importantly, exercise is a potent stimulator of muscle synthesis, and therefore this therapy may reverse muscle damage caused by cancer cachexia.

癌症恶病质的进行性骨骼肌萎缩涉及一个蛋白质合成和分解失调的过程。这种分解代谢可能是营养不良、促炎细胞因子和泛素蛋白酶体途径(UPP)上调的结果，UPP随后会增加肌肉生长抑制素和激活素A的释放。与癌症恶病质相关的骨骼肌萎缩具有重要的临床意义，它可能导致治疗毒性或过早停止治疗，导致发病率和死亡率增加。因此，有必要进一步研究癌症恶病质中肌肉萎缩的病理生理机制，以制定有效的预防和治疗措施。几项研究已经确定了慢性全身性炎症在癌症患者肌肉萎缩的启动和延续中所起的核心作用。有趣的是，虽然运动显示出改善肌肉质量的功效，但直到最近，研究人员才开始评估运动对慢性全身性炎症的影响。为了将这些新信息与已建立的范式结合起来，我们回顾了几种可能导致癌症患者肌肉萎缩的生物学途径(如功能失调的炎症反应、下丘脑垂体肾上腺轴和肌肉生长抑制素/激活素A活性增加)。此外，我们还讨论了运动在治疗癌症相关肌肉萎缩过程中对这些途径的潜在影响。在这一人群中，运动是一种有吸引力的肌肉萎缩干预措施，部分原因是它破坏了慢性全身炎症介导的分解代谢。最重要的是，运动是肌肉合成的有力刺激物，因此这种疗法可以逆转由癌症恶病质引起的肌肉损伤。

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引用次数: 0

Body composition skeletal muscle analysis in cancer cachexia studies: Is there a place for 3T MRI analysis? 癌症恶病质研究中的身体成分骨骼肌分析:3T MRI分析是否有一席之地?

JCSM clinical reports

Pub Date : 2018-07-01 DOI: 10.17987/jcsm-cr.v3i2.59

Elaine S Rogers, William Ormiston, Rachel Heron, Beau Pontré, Roderick MacLeod, Anthony Doyle

Aims

Cancer cachexia is a condition often seen in end stage Non-Small Cell Lung Cancer (NSCLC) patients. Recent developments include the use of pharmaceutical agents and/or exercise to induce stability/hypertrophy of muscle volume. This requires accurate assessment of the change in both quantity and quality of the muscle during cancer cachexia clinical studies. Magnetic Resonance Imaging (MRI) is appropriately placed to address both of these factors. The present study aimed to investigate total quadriceps muscle volume change by 3T MRI within a cancer cachexia clinical study.

Methods and results

Auckland's Cancer Cachexia evaluating Resistance Training (ACCeRT) study is a randomised controlled feasibility study investigating eicosapentaenoic acid (EPA) and cyclo-oxygenase-2 (COX-2) inhibitor (celecoxib) (Arm A) versus EPA, COX-2 inhibitor (celecoxib), Progressive Resistance Training (PRT) plus essential amino acids (EAAs) high in leucine (Arm B) in NSCLC cachectic patients. All participants underwent 3T MRI scanning at baseline and at last or end of trial (EOT) visit. Analysis showed a mean total quadriceps muscle volume percentage change from baseline to EOT of +12.5% (Arm A), compared with −3% (Arm B). There was a difference in muscle volume between genders. Arm B participant data showed a percentage change of +4.2% within females (n=2) compared with −10.2% (n=2) within males at EOT visit. All EOT results suggests the use of EPA and celecoxib +/- PRT and EAAs could potentially preserve muscle volume loss during refractory cachexia.

Conclusions

ACCeRT is the first study to utilise 3T MRI total quadriceps muscle volume within a cancer cachexia study, along with the first in an end-stage/refractory cachexia population. These results can be used for baseline/reference for future cancer cachexia studies targeting the anabolic muscle pathways in end-stage/refractory cachexia patients.

目的恶性恶病质是终末期非小细胞肺癌(NSCLC)患者的常见病。最近的发展包括使用药物和/或运动来诱导肌肉体积的稳定/肥大。这就需要在癌症恶病质临床研究中对肌肉数量和质量的变化进行准确的评估。磁共振成像(MRI)被适当地放置来解决这两个因素。本研究旨在通过3T MRI研究癌症恶病质临床研究中的股四头肌总体积变化。奥克兰癌症恶病质评估阻力训练(ACCeRT)研究是一项随机对照可行性研究，调查了二十碳五烯酸(EPA)和环氧化酶-2 (COX-2)抑制剂(塞来昔布)(Arm a)与EPA、COX-2抑制剂(塞来昔布)、进行性阻力训练(PRT)加高亮氨酸必需氨基酸(EAAs) (Arm B)在非小细胞肺癌恶病质患者中的作用。所有参与者在基线和最后一次或试验结束时(EOT)进行了3T MRI扫描。分析显示，从基线到EOT的平均总股四头肌肌肉体积百分比变化为+12.5% (a组)，而- 3% (B组)。肌肉体积在性别之间存在差异。B组参与者数据显示，在EOT就诊时，女性患者的百分比变化为+4.2% (n=2)，而男性患者的百分比变化为- 10.2% (n=2)。所有EOT结果表明，EPA和塞来昔布+/- PRT和eaa的使用可能会保护难治性恶病质期间的肌肉体积损失。ACCeRT是第一个在癌症恶病质研究中使用3T MRI总股四头肌体积的研究，也是第一个在终末期/难治性恶病质人群中使用的研究。这些结果可为未来针对终末期/难治性恶病质患者的合成代谢肌肉通路的癌症恶病质研究提供基线/参考。

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引用次数: 0

Pretiree lifestyles in relation to musculoskeletal health: cross-sectional data from the Geelong Osteoporosis Study 老年生活方式与肌肉骨骼健康的关系:来自吉隆骨质疏松症研究的横断面数据

JCSM clinical reports

Pub Date : 2018-07-01 DOI: 10.17987/jcsm-cr.v3i2.72

Julie A. Pasco, Kara L Holloway-Kew, Natalie K Hyde, Monica C Tembo, Pamela G Rufus, Sophia X Sui, Michael Berk, Mark A Kotowicz

Aims

What happens in the early-elderly ‘pretiree’ period potentially influences the divergent paths of healthy or unhealthy ageing. In this cross-sectional study, we aimed to profile musculoskeletal health and lifestyle behaviours for men and women in their late-fifties and sixties.

Methods and results

For 482 participants from the Geelong Osteoporosis Study, we measured DXA-derived relative appendicular lean mass (rALM), bone mineral density (BMD) at the femoral neck and percentage body fat mass (%BF). Low-rALM and low-BMD referred to sex-specific T-scores<-1.0. Associations between exposures and low-rALM and/or low-BMD were explored using multivariable logistic regression. Three-quarters of participants had high %BF, 98(20.3%) had low-rALM, 202(41.9%) had low-BMD and 63(13.1%) had both low-rALM and low-BMD. Eight-two (17.0%) were very active and one-third participated in sports/recreational activities. Most [n=416(87.8%)] met the recommended daily intake (RDI) for protein; only 119(25.1%) met the RDI for calcium. Less than 10% smoked and one-third exceeded recommended alcohol intakes. Independent of age, weight and sex, greater %BF and sedentary behaviour increased the likelihood of low-rALM; high-alcohol consumption increased the likelihood of low-BMD; and greater %BF increased the likelihood of low-rALM and low-BMD combined.

Conclusions

One-half of participants had rALM and BMD in the normal range. Only a few were involved in resistance-training or weight-bearing exercise, despite having the capacity to be physically active. As sedentary lifestyles, excessive adiposity and high alcohol use were associated with low-rALM and/or low-BMD, we propose that these adverse factors be potential targets among pretirees to minimise their risk of entering old age with poor musculoskeletal health.

目的在老年早期“pre - tiree”时期发生的事情可能会影响健康或不健康老龄化的不同路径。在这项横断面研究中，我们的目的是分析50多岁和60多岁男性和女性的肌肉骨骼健康和生活方式行为。方法和结果对于来自Geelong骨质疏松研究的482名参与者，我们测量了dda衍生的相对阑尾瘦质量(rALM)、股骨颈骨矿物质密度(BMD)和体脂质量百分比(%BF)。低ralm和低bmd指的是性别特异性T-scores<-1.0。使用多变量逻辑回归探讨暴露与低ralm和/或低bmd之间的关系。四分之三的参与者有高%BF, 98(20.3%)有低ralm, 202(41.9%)有低骨密度，63(13.1%)有低ralm和低骨密度。82人(17.0%)非常活跃，三分之一参加体育/康乐活动。大多数[n=416(87.8%)]达到每日推荐蛋白质摄入量(RDI);只有119例(25.1%)达到钙的推荐摄入量。不到10%的人吸烟，三分之一的人饮酒过量。与年龄、体重和性别无关，较大的BF和久坐行为增加了低ralm的可能性;大量饮酒增加了低骨密度的可能性;更高的BF百分比增加了低ralm和低bmd合并的可能性。半数受试者的rALM和BMD在正常范围内。只有少数人参加了阻力训练或负重运动，尽管他们有能力进行身体活动。由于久坐不动的生活方式、过度肥胖和大量饮酒与低ralm和/或低骨密度相关，我们建议这些不利因素是潜在的目标，以尽量减少他们进入老年时肌肉骨骼健康状况不好的风险。

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引用次数: 5

Wasting in Chronic Kidney Disease – a Complex Issue 慢性肾脏疾病中的消耗——一个复杂的问题

JCSM clinical reports

Pub Date : 2018-07-01 DOI: 10.17987/jcsm-cr.v3i2.63

Adrian D Slee, Joanne Reid

Chronic kidney disease (CKD) has become a global health burden and is associated with increased morbidity and mortality. In particular, wasting is highly prevalent in later stages of the illness with muscle loss being a common problem. The aetiology and progression of this wasting is complex and multiple states have been identified linked to wasting in CKD. These include: ‘malnutrition’, ‘disease-related malnutrition’, ‘protein-energy wasting’, ‘cachexia’, ‘sarcopenia’, ‘frailty’ and ‘muscle wasting‘. The purpose of this paper is to review these terms in the context of CKD. Common features include weight loss, loss of muscle mass and muscle function principally driven by CKD disease specific factors and inflammatory mediators. Disease-related malnutrition would appear to be a more appropriate term for CKD than malnutrition as it take in to consideration disease specific factors such as inflammation for example. Frailty is commonly associated with age-related decline in physiological function. Development of novel screening tools measuring across multiple domains of nutritional status, muscle and physical function may be useful in CKD. Research into potential treatments are currently underway with focus on multi-modal therapies including nutrition, resistance training and anabolic drugs such as myostatin blockade and selective androgen receptor modulators. A better understanding of different states and terms may help guide assessment and treatment opportunities for patients.

慢性肾脏疾病(CKD)已成为全球健康负担，并与发病率和死亡率增加有关。特别是，消瘦在疾病的后期阶段非常普遍，肌肉损失是一个常见的问题。这种消耗的病因和进展是复杂的，多种状态已被确定与CKD中的消耗有关。这些包括:“营养不良”、“与疾病有关的营养不良”、“蛋白质-能量浪费”、“恶病质”、“肌肉减少症”、“虚弱”和“肌肉萎缩”。本文的目的是在CKD的背景下回顾这些术语。常见的特征包括体重减轻，肌肉质量和肌肉功能的丧失，主要由CKD疾病的特定因素和炎症介质驱动。与疾病相关的营养不良似乎比营养不良更适合CKD，因为它考虑了疾病特定因素，例如炎症。虚弱通常与年龄相关的生理功能下降有关。开发新的筛查工具，测量营养状况、肌肉和身体功能的多个领域，可能对慢性肾病有用。对潜在治疗方法的研究目前正在进行中，重点是多模式治疗，包括营养，阻力训练和合成代谢药物，如肌肉生长抑制素阻断剂和选择性雄激素受体调节剂。更好地了解不同的状态和术语可能有助于指导患者的评估和治疗机会。

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引用次数: 7

Resistance Training Frequency Confers Greater Muscle Quality in Aged Individuals: A Brief NHANES Report 抗阻训练频率赋予老年人更高的肌肉质量:一份简短的NHANES报告

JCSM clinical reports

Pub Date : 2018-07-01 DOI: 10.17987/jcsm-cr.v3i2.64

Marshall A. Naimo, Ja K. Gu, Christa Lilly, George A. Kelley, Brent A. Baker

Aims

Sarcopenia, the age-related decline in skeletal muscle mass, results in a loss of strength and functional capacity, which subsequently increases the risk of disease, disability frailty, and all-cause mortality. Skeletal muscle quality (MQ), i.e., strength per unit muscle mass, is the ability of muscle to perform its functions, and evidence indicates it is a more influential variable underlying age-related declines in muscle function than losses in muscle mass. Resistance training (RT) is known for enhancing skeletal MQ, improving health span, and reducing mortality. However, to the best of our knowledge, no studies have examined the relationship between RT frequency and MQ in an aged population. Thus, this study was designed to test the hypothesis that greater MQ in older individuals is associated with RT frequency.

Methods and Results

Utilizing data from 2,391 older adults in the National Health and Nutrition Survey (NHANES; 1999–2002), a secondary analysis of data was performed to see if an association existed between RT frequency and MQ in persons aged 55 years and older. Data were analyzed using analysis of covariance (ANCOVA) with three different models. Individuals were stratified into two groups based on how many days per week they performed RT: Insufficient (i.e., < two days per week) or sufficient (≥ two days per week). Muscle quality was calculated by taking the average peak force (Newtons) obtained from an isokinetic dynamometer and dividing it by lean mass, excluding bone mineral content (grams), obtained from dual-energy X-ray absorptiometry. The alpha level was set at <0.05. For persons aged 55 and over, a statistically significant association was found between sufficient RT and greater MQ in both unadjusted as well as adjusted models that accounted for various demographic, behavioral, and clinical characteristics (p<0.05 for all). However, when limited to those 65 and older, no statistically significant associations were observed between sufficient RT and greater MQ (p≥0.05 for all). When partitioned according to those 55 to 64 years of age and those 55 to 79 years, a statistically significant association was again observed (p<0.05 for all). No statistically significant associations were observed for individuals 65–79 years of age or those 80 years of age and older (p≥0.05 for all).

Conclusions

Sufficient amounts of RT are associated with greater MQ in selected older individuals. A need exists for future randomized controlled trials that examine the dose-response relationship between resistance training and MQ in

骨骼肌减少症是骨骼肌质量与年龄相关的下降，导致力量和功能丧失，从而增加疾病、残疾、虚弱和全因死亡率的风险。骨骼肌质量(MQ)，即单位肌肉质量的力量，是肌肉执行其功能的能力，有证据表明，与肌肉质量损失相比，骨骼肌质量是与年龄相关的肌肉功能下降的一个更有影响力的变量。阻力训练(RT)以增强骨骼MQ、改善健康跨度和降低死亡率而闻名。然而，据我们所知，还没有研究调查过老年人群中RT频率和MQ之间的关系。因此，本研究的目的是验证老年人较高的MQ与RT频率相关的假设。方法和结果利用全国健康和营养调查(NHANES;1999-2002)，对数据进行了二次分析，以了解55岁及以上人群中RT频率和MQ之间是否存在关联。采用三种不同模型的协方差分析(ANCOVA)对数据进行分析。根据他们每周进行多少天的RT，将个体分为两组:不足(即<每周2天)或足够(每周≥2天)。肌肉质量是通过等速测力仪获得的平均峰值力(牛顿)除以双能x射线吸收仪获得的瘦肉质量(不包括骨矿物质含量(克))来计算的。α水平设为<0.05。对于55岁及以上的人，在考虑各种人口统计学、行为和临床特征的未调整模型和调整模型中，充分的RT和更高的MQ之间存在统计学上显著的关联(p < 0.05)。然而，当限于65岁及以上的患者时，在足够的RT和更高的MQ之间没有统计学意义上的显著关联(p≥0.05)。当按55 ~ 64岁和55 ~ 79岁分组时，再次观察到统计学上显著的相关性(p < 0.05)。65 ~ 79岁或80岁及以上的个体无统计学意义的关联(p均≥0.05)。结论:在某些老年人中，足够量的RT与较高的MQ相关。未来有必要进行随机对照试验，以检验老年人抗阻训练和MQ之间的剂量-反应关系。

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引用次数: 3

Sarcopenia, Relative Sarcopenia and Excess Adiposity in Chronic Kidney Disease 慢性肾脏疾病中的肌肉减少症、相对肌肉减少症和过度肥胖

JCSM clinical reports

Pub Date : 2018-01-01 DOI: 10.17987/jcsm-cr.v3i1.55

Susan L Ziolkowski, Jin Long, Joshua F Baker MD, Julia F Simard, Glenn M Chertow, Mary B Leonard

Aims

Conventional definitions of sarcopenia based on lean mass fail to capture low lean mass relative to fat mass, i.e., relative sarcopenia. Unlike percent body fat (%BF) and Quételet's (body mass) index (BMI, kg/m²), definitions of obesity based on fat mass index (FMI, kg/m²) are not confounded by lean mass. The objective is to determine the prevalence of sarcopenia, relative sarcopenia, and obesity in CKD, and determine if CKD is associated with relative sarcopenia and obesity, independent of demographics and comorbidities.

Methods and Results

DXA-derived appendicular lean mass index (ALMI, kg/m²) and FMI were assessed in 13,980 NHANES participants. ALMI, FMI, and ALMI relative to FMI (ALMI _FMI) were expressed as sex- and race/ethnicity-specific standard deviation scores compared with young adults (T-scores) and by age (Z-scores). Sarcopenia was defined as ALMI T-score < −2, relative sarcopenia as ALMI _FMI T-score < −2, and low lean mass relative to fat mass for age as ALMI _FMI Z-score < −1. Obesity was defined using conventional BMI and %BF cutpoints and as sex- and race/ethnicity-specific FMI cutpoints. Glomerular filtration rate (GFR) was estimated using creatinine- (eGFR_Cr) and cystatin C- (eGFR_Cys). The prevalence of relative sarcopenia was higher than the prevalence of sarcopenia, especially in CKD stages 3b and 4 using eGFR_Cr; these CKD stages were associated with the highest FMI. CKD stage was independently associated with low ALMI _FMI for age using eGFR_Cys. BMI underestimated and %BF overestimated the prevalence of obesity compared with FMI. CKD was not independently associated with obesity by FMI.

Conclusions

In CKD, conventional definitions of sarcopenia underestimate muscle deficits and %BF overestimates the prevalence of obesity. CKD is independently associated with relative sarcopenia, but not excess adiposity.

目的基于瘦质量的肌肉减少症的传统定义未能捕获相对于脂肪质量的低瘦质量，即相对肌肉减少症。与体脂百分比(%BF)和体重指数(BMI, kg/m2)不同，基于脂肪质量指数(FMI, kg/m2)的肥胖定义不会与瘦体重混淆。目的是确定CKD中肌肉减少症、相对肌肉减少症和肥胖的患病率，并确定CKD是否与相对肌肉减少症和肥胖相关，独立于人口统计学和合并症。方法与结果对13980名NHANES参与者进行dxa衍生的阑尾瘦质量指数(ALMI, kg/m2)和FMI评估。ALMI, FMI和ALMI相对于FMI (ALMI FMI)表示为与年轻人(t分数)和年龄(z分数)相比的性别和种族/民族特定的标准差分数。肌少症定义为ALMI T-score <−2，相对肌肉减少症为ALMI FMI T-score <−2，与年龄相关的瘦肉质量相对于脂肪质量较低，如ALMI FMI Z-score <−1。肥胖的定义使用传统的BMI和%BF切点，以及性别和种族/民族特定的FMI切点。用肌酐- (eGFRCr)和胱抑素C- (eGFRCys)估计肾小球滤过率(GFR)。使用eGFRCr，相对肌少症的患病率高于肌少症的患病率，特别是在CKD 3b期和4期;这些CKD分期与最高的FMI相关。使用eGFRCys, CKD分期与低ALMI FMI年龄独立相关。与FMI相比，BMI低估了肥胖患病率，而%BF高估了肥胖患病率。通过FMI, CKD与肥胖没有独立的相关性。在CKD中，肌肉减少症的传统定义低估了肌肉缺陷，而%BF高估了肥胖的患病率。CKD与相对肌肉减少症独立相关，但与过度肥胖无关。

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引用次数: 12

Relationship between sarcopenia and the serum creatinine/cystatin C ratio in Japanese rural community-dwelling older adults 日本农村社区老年人肌肉减少症与血清肌酐/胱抑素C比值的关系

JCSM clinical reports

Pub Date : 2018-01-01 DOI: 10.17987/jcsm-cr.v3i1.57

Hiroshi Kusunoki, Shotaro Tsuji, Yosuke Wada, Mayuka Fukai, Koutatsu Nagai, Masako Itoh, Kyoko Sano, Kayoko Tamaki, Yoshinori Ohta, Manabu Amano, Hatsuo Maeda, Yoko Hasegawa, Hiromitsu Kishimoto, Soji Shimomura, Hiroo Yoshikawa, Ken Shinmura

Aims

Sarcopenia, the age-related decline in skeletal muscle volume and function, is associated with negative clinical and socioeconomic outcomes in elderly people. Clinical biomarkers to diagnose sarcopenia that can be quantified in a reliable, and cost- effective manner, are needed. We investigated whether the creatinine (Cr) /cystatin C (CysC) ratio is correlated with muscle volume and physical function in Japanese community-dwelling elderly subjects.

Methods and results

The present study included 213 men aged 73.2±6.2 years and 464 women aged 72.4±5.5 years from a rural area in the Hyogo prefecture of Japan. To evaluate whether the Cr/CysC ratio is correlated with sarcopenia criteria in elderly individuals without severe renal impairment, we excluded subjects with estimate glomerular filtration rate (eGFR) <45.

The prevalence of sarcopenia diagnosed according to the AWGS criteria was 2.8% in men and 3.4% in women. The Cr/CysC ratio correlated with skeletal mass index (r = 0.49, p <0.0001), skeletal muscle mass (r = 0.53, p <0.0001), grip power (r = 0.59, p <0.0001), knee extension muscle strength (r = 0.49, p <0.0001), normal gait speed (r = 0.18, p <0.0001), and maximal gait speed (r = 0.32, p <0.0001). A negative correlation between the Cr/CysC ratio and, body fat mass (r = −0.20, p <0.0001) and percentage of body fat mass (r = −0.39, p <0.0001) was observed. In a multiple regression analysis, Cr/CysC was also found to be significantly positively correlated with each component of the sarcopenia criteria.

Conclusions

Even in elderly individuals without severe renal impairment, the Cr/CysC ratio was positively correlated with muscle volume and physical function and negatively correlated with body fat mass. Therefore, the Cr/CysC ratio might be a useful biomarker to predict sarcopenia.

目的骨骼肌减少症，骨骼肌体积和功能与年龄相关的下降，与老年人的负面临床和社会经济结果有关。临床生物标志物诊断肌肉减少症，可以量化可靠，成本效益的方式，是需要的。我们调查了日本社区老年人肌酐(Cr) /胱抑素C (CysC)比值是否与肌肉体积和身体功能相关。方法与结果本研究纳入了来自日本兵库县农村的213名男性(73.2±6.2岁)和464名女性(72.4±5.5岁)。为了评估Cr/CysC比值是否与无严重肾功能损害的老年人肌肉减少症标准相关，我们排除了估算肾小球滤过率(eGFR) [lt;45]的受试者。根据AWGS标准诊断的肌肉减少症患病率在男性中为2.8%，在女性中为3.4%。Cr/CysC比值与骨量指数(r = 0.49, p <0.0001)、骨骼肌质量(r = 0.53, p <0.0001)、握力(r = 0.59, p <0.0001)、膝关节伸肌力量(r = 0.49, p <0.0001)、正常步速(r = 0.18, p <0.0001)、最大步速(r = 0.32, p <0.0001)相关。Cr/CysC比值与体脂质量(r = - 0.20, p <0.0001)和体脂质量百分比(r = - 0.39, p <0.0001)呈负相关。在多元回归分析中，还发现Cr/CysC与肌少症标准的各个组成部分显著正相关。结论即使在没有严重肾功能损害的老年人中，Cr/CysC比值也与肌肉体积和身体功能呈正相关，与体脂量呈负相关。因此，Cr/CysC比值可能是预测肌少症的一个有用的生物标志物。

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引用次数: 27

Relationship between hand grip strength and peak VO2 in community-dwelling elderly outpatients 社区老年门诊患者握力与VO2峰值的关系

JCSM clinical reports

Pub Date : 2018-01-01 DOI: 10.17987/jcsm-cr.v3i1.48

Masamitsu Sugie MD, Kazumasa Harada MD, Tetsuya Takahashi PhD, Marina Nara MSc, Joji Ishikawa MD, Jun Tanaka MD, Teruyuki Koyama MD, Hajime Fujimoto MD, Shuichi Obuchi PhD, Shunei Kyo MD, Hideki Ito MD

Background

Hand grip strength and peak oxygen uptake (VO₂) are important components of frailty. However, the relationship between these two variables among community-dwelling elderly people is still unclear. The present study aimed to investigate this relationship.

Methods

Participants were 190 Japanese community-dwelling elderly outpatients (61 men and 129 women, mean age 78.0 years). Hand grip strength of participants' was measured using a Smedley-type hand dynamometer. Peak VO₂ levels were assessed with a cardiopulmonary exercise test. Skeletal muscle mass index (SMI) and usual walking speed were assessed physiologically and physically. Sample size was calculated using G*Power 3.1.9.2.

Results

There were significant correlations between hand grip strength and age (r = −0.22), peak VO₂ (r = 0.40), SMI (r = 0.51), and usual walking speed (r = 0.29). There were significant differences in age, peak VO₂ and SMI after participants were divided into normal and low hand grip strength groups according to the Asian Working Group for Sarcopenia threshold, whether both sexes were combined or considered separately. Multiple logistic regression analysis showed that peak VO₂, SMI and age were independent determinants of hand grip strength after adjusting for potential confounders (Exp(B) = 0.871; 0.475; 1.065). Longitudinal analysis after 6 months of exercise training showed the percentage of change in hand grip strength and peak VO₂ were correlated positively (r = 0.22) for 92 participants.

Conclusion

Peak VO₂ is independently associated with hand grip strength among community-dwelling elderly outpatients.

手掌握力和峰值摄氧量(VO2)是虚弱的重要组成部分。然而，在社区居住的老年人中，这两个变量之间的关系尚不清楚。本研究旨在探讨这种关系。方法研究对象为190例日本社区老年门诊患者(男性61例，女性129例，平均年龄78.0岁)。用smedley型手测力仪测量了手握力。通过心肺运动试验评估峰值VO2水平。骨骼肌质量指数(SMI)和正常步行速度进行生理和生理评估。样本量采用G*Power 3.1.9.2计算。结果握力与年龄(r = - 0.22)、VO2峰值(r = 0.40)、SMI (r = 0.51)、平时步行速度(r = 0.29)有显著相关。根据亚洲肌肉减少症阈值工作组将参与者分为正常和低握力组后，无论男女合并还是单独考虑，年龄，峰值VO2和SMI都有显著差异。多元logistic回归分析显示，调整潜在混杂因素后，VO2峰值、SMI和年龄是手握力的独立决定因素(Exp(B) = 0.871;0.475;1.065)。运动训练6个月后的纵向分析显示，92名参与者的握力变化百分比与峰值VO2呈正相关(r = 0.22)。结论社区老年门诊患者VO2峰值与握力独立相关。

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引用次数: 13

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair. 肌少症是腹主动脉瘤修复后死亡率的重要预测因子。

JCSM clinical reports

Pub Date : 2018-01-01

Joshua K Kays, Tiffany W Liang, Teresa A Zimmers, Daniel P Milgrom, Hamzah Abduljabar, Andrew Young, Bradford J Kim, Teresa M Bell, Andres Fajardo, Michael P Murphy, Leonidas G Koniaris

Aims: Repair of abdominal aortic aneurysms (AAA) decreases the incidence of rupture and death. In cancer patients, sarcopenia has been associated with increased surgical complications and mortality. The impact of sarcopenia on survival after AAA repair has yet to be described.

Methods and results: Patient demographic, laboratory, body composition measurements and survival data were obtained from patients undergoing AAA repair at the Indiana University medical campus over a 5-year period. Univariate and multivariate analyses were performed to identify factors associated with overall survival. Overall, 58.2% presented with sarcopenia. Sarcopenic patients were older (71.8±8.3 versus 66.8±8.1 years; p<0.001), had lower body mass index (BMI) (26.3±5.2 versus 31.5±5.9 kg/m²; p<0.001), higher rates of myosteatosis (84.4% versus 52.%; p<0.001), greater AAA diameter (60.6±14.0 versus 57.8±11.7 mm; p=0.016), higher Charlson Comorbidity Index (CCI) (32.3% versus 25.1% ≥6; p=0.034), and increased rates of rupture (8.2% versus 3.8%; p=0.047). Sarcopenic and nonsarcopenic patients had no difference in 30-day morbidity (8.5% versus 8.5%; p=0.991) or mortality (3.7% versus 0.9%; p=0.07). Univariate analysis demonstrated age, sarcopenia, myosteatosis, CCI, and BMI to be associated with long-term survival. There was no correlation between BMI and sarcopenia. Both sarcopenia and myosteatosis resulted in decreased one-, three-, and five-year survivals compared to their counterparts. On multivariate analysis sarcopenia is independently associated with survival, conferring a 1.6-fold increase in death (p=0.04). The combination of sarcopenia plus myosteatosis doubled the risk of death compared to sarcopenia alone.

Conclusions: This is the first study to demonstrate that over half of all patients undergoing AAA repair are sarcopenic, a condition associated with increased mortality. Sarcopenia with myosteatosis is associated with double the mortality of sarcopenia alone. CT scan, but not BMI, accurately identifies sarcopenia and myosteatosis. Defining the mechanisms through which sarcopenia contributes to late death after AAA repair is critical to developing novel interventions that may improve survival in this high risk population.

目的:腹主动脉瘤(AAA)的修复可降低破裂和死亡的发生率。在癌症患者中，肌肉减少症与手术并发症和死亡率增加有关。肌少症对AAA修复后存活的影响尚未被描述。方法和结果:从印第安纳大学医学院接受AAA修复的患者中获得患者人口统计学、实验室、身体成分测量和生存数据，为期5年。进行单因素和多因素分析以确定与总生存率相关的因素。总体而言，58.2%表现为肌肉减少症。肌肉减少症患者年龄较大(71.8±8.3岁vs 66.8±8.1岁);p2;结论:这是第一个研究表明，超过一半的接受AAA修复的患者是肌肉减少，这种情况与死亡率增加有关。肌少症合并骨骼肌病的死亡率是单纯肌少症的两倍。CT扫描，而不是BMI，可以准确地识别肌肉减少症和肌骨化症。明确肌少症导致AAA修复后晚期死亡的机制，对于开发新的干预措施，提高这一高危人群的生存率至关重要。

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引用次数: 0

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