精准健康时代的 "肌肉疏松症":实现健康长寿的个性化干预。

Liang-Kung Chen
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摘要

肌肉疏松症以骨骼肌质量和功能的逐渐丧失为特征,严重影响老年人的健康状况。本综述探讨了肌肉疏松症研究的发展状况,尤其关注其在亚洲人群中的独特特征以及新兴的药物干预措施。最近的研究发现,亚洲成年人(尤其是女性)肌肉质量下降的模式与众不同,这对全球肌肉疏松症诊断标准的普遍应用提出了挑战。亚洲肌肉疏松症工作组提出了针对特定地区的诊断标准,承认了这些种族差异。据估计,在社区居住的老年人中,肌肉疏松症的患病率差异很大,从 10%到 40%不等。就特定慢性疾病而言,肌肉疏松症的患病率明显更高,心血管疾病的患病率为 35%,慢性肾脏疾病的患病率为 24.5%。肌肉疏松症与各种慢性疾病密切相关,会使跌倒风险增加 1.5-3 倍,并使死亡风险显著增加 29-51%。目前的治疗策略主要包括抗阻力运动和营养干预,建议每日蛋白质摄入量至少为每公斤 1.2 克,以维持肌肉健康。药物开发取得了显著进展,目前有 20 多种化合物处于不同的临床试验阶段。其中包括肌促性蛋白抑制剂、选择性雄激素受体调节剂、胃泌素受体激动剂、间充质干细胞疗法和绒毛蛋白基因疗法。然而,由于亚洲人独特的饮食模式、文化背景和潜在的不同药物反应,有必要采取量身定制的干预措施,并进行针对亚洲人的临床试验。未来的发展方向包括完善针对亚洲人的诊断标准,在多个亚洲国家开展大规模流行病学研究,开发适合亚洲文化的干预措施,将肌肉疏松症治疗纳入慢性病护理,以及推进以亚洲人群为重点的药物研究。总之,肌肉疏松症是衰老过程中的一个关键环节,与多个器官系统和慢性疾病有着错综复杂的联系,因此必须将其视为以人为本的护理和全面应对与年龄相关的健康挑战的基石。
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Sarcopenia in the era of precision health: Toward personalized interventions for healthy longevity.

Sarcopenia, characterized by the progressive loss of skeletal muscle mass and function, significantly impacts health outcomes in older adults. This review explores the evolving landscape of sarcopenia research, with a particular focus on its unique characteristics in Asian populations and emerging pharmaceutical interventions. Recent studies have revealed distinct patterns of muscle mass decline in Asian adults, particularly in women, challenging the universal application of global sarcopenia diagnostic criteria. The Asian Working Group for Sarcopenia has proposed region-specific diagnostic criteria, acknowledging these ethnic variations. Prevalence estimates of sarcopenia vary widely, ranging from 10% to 40% in community-dwelling older adults. For specific chronic conditions, the prevalence of sarcopenia is notably higher, reaching 35% for cardiovascular diseases and 24.5% for chronic kidney disease. Sarcopenia is strongly associated with various chronic conditions, increasing the risk of falls by 1.5 to 3 times and significantly increasing mortality risk by 29% to 51%. Current management strategies primarily involve resistance exercise and nutritional interventions, with a recommended daily protein intake of at least 1.2 g/kg to maintain muscle health. Pharmaceutical development has gained significant momentum, with over 20 compounds in various stages of clinical trials. These include myostatin inhibitors, selective androgen receptor modulators, ghrelin receptor agonists, mesenchymal stem cell therapy, and follistatin gene therapy. However, the unique dietary patterns, cultural contexts, and potentially distinct drug responses in Asian populations necessitate tailored interventions and Asia-specific clinical trials. Future directions include refining Asian-specific diagnostic criteria, conducting large-scale epidemiological studies across multiple Asian countries, developing culturally appropriate interventions, integrating sarcopenia management into chronic disease care, and advancing pharmaceutical research with a focus on Asian populations. In conclusion, sarcopenia emerges as a critical nexus in the aging process, intricately linked with multiple organ systems and chronic conditions, underscoring the imperative for its recognition as a cornerstone in person-centered care and the holistic management of age-related health challenges.

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