Advances in research on acute sarcopenia in older adults
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摘要: 急性肌少症是一种常见于老年人的肌肉病变，主要由急性疾病、手术或住院等应激事件引发，表现为肌肉质量和功能的快速丧失。随着全球老龄化的加速，急性肌少症已成为重要的公共健康问题，显著影响患者的生活质量和预后。肌少症的发生与年龄增长过程中的生理性变化密切相关，老年人活动量逐渐减少，伴随肌肉生理性减少，叠加衰弱、营养不良和骨质疏松等因素，使得肌少症的诱发风险增加。研究表明，住院老年患者中急性肌少症的发生率较高，然而，由于缺乏常规的肌肉质量和功能评估，其诊断率较低，实际发生率可能被低估。急性肌少症不仅会延长患者的住院时间，还会增加并发症和死亡风险，严重影响患者的预后和生活质量。急性肌少症的发病机制复杂，主要涉及肌肉废用、炎症反应、内分泌紊乱及线粒体损伤等多个方面。针对急性肌少症的干预措施包括运动锻炼、营养干预、神经肌肉电刺激和药物治疗等。尽管在急性肌少症的研究中取得了一定进展，但在发病机制、诊断标准和治疗策略等方面仍面临诸多挑战。未来的研究应着重阐明急性肌少症的分子机制，开发早期诊断指标，优化个体化治疗方案，并建立以老年医学科为主导的多学科协作诊疗模式，以提高临床诊疗水平。鉴于此，本文对急性肌少症的最新研究进展进行了综述，包括其定义、流行病学特征、发病机制、治疗策略及预防措施，旨在为临床医师提供有效的诊疗思路，并为未来的研究提供参考。Abstract: Acute sarcopenia is a muscle disorder commonly observed in the elderly, primarily triggered by acute diseases, surgeries, or hospitalization-related stress events, and is characterized by a rapid loss of muscle mass and function. With the acceleration of global population aging, acute sarcopenia has emerged as a critical public health challenge, exerting a substantial negative impact on patients' quality of life and clinical prognosis. The development of sarcopenia is closely associated with age-related physiological changes, including a gradual reduction in physical activity and progressive physiological muscle decline. These changes are often exacerbated by comorbid factors such as frailty, malnutrition, and osteoporosis, which increase the risk of sarcopenia. Research indicates a high incidence of acute sarcopenia among hospitalized elderly patients. However, due to the lack of routine muscle mass and function assessments in clinical practice, diagnostic rates remain low and actual prevalence is likely underestimated. Acute sarcopenia not only prolongs patient hospitalization but also increases complications and mortality risks, thereby markedly worsening patient outcomes and life quality. The pathogenesis of acute sarcopenia is complex, primarily involving muscle disuse, inflammatory responses, endocrine disorders, and mitochondrial damage. Intervention strategies for acute sarcopenia encompass exercise training, nutritional interventions, neuromuscular electrical stimulation, and pharmacological treatments. Despite notable research progress, significant challenges remain in elucidating the molecular mechanisms, establishing diagnostic standards, and developing therapeutic strategies. Future research should prioritize the identification of early diagnostic markers, the optimization of personalized treatment approaches, and the establishment of multidisciplinary diagnostic and management models led by geriatric medicine to enhance clinical outcomes. Accordingly, this review comprehensively summarizes the latest research advances in acute sarcopenia, including its definition, epidemiological characteristics, pathogenesis, treatment strategies, and preventive measures, aiming to provide clinicians with effective diagnostic and therapeutic insights and directions for future investigations.
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Key words:
- Acute sarcopenia /
- Skeletal muscle /
- Muscle wasting /
- Functional impairment /
- Clinical intervention
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表 1 肌少症的诊断界值
Table 1. Diagnostic thresholds of sarcopenia
指标 欧洲老年人肌少症工作组 亚洲肌少症工作组 肌少症定义和预后联盟 项目 诊断界值 项目 诊断界值 项目 诊断界值 肌肉力量 抓握力 < 27.0 kg(男)； < 16.0 kg(女) 抓握力 < 28.0 kg(男)； < 18.0 kg(女) 抓握力 < 35.5 kg(男)； < 20.0 kg(女) 5次起坐测试 >15 s 肌肉质量 四肢骨骼肌量 < 20 kg(男)； < 15 kg(女) 非必须 四肢骨骼(肌量/身高2) < 7.0 kg/m2 (男)； < 5.5 kg/m2 (女) 四肢骨骼(肌量/身高2) < 7.0 kg/m2 (男)； < 5.4 kg/m2 (女) 肌肉性能 步态速度 ≤0.8 m/s 步态速度 ≤1.0 m/s 步态速度 < 0.8 m/s 简易体能状况量表 ≤8分 简易功能状态评估量表 ≤9分 起立行走计时测试 ≥20 s 5 min椅子站立测试 ≥12 s 400 m走测试 未完成或≥6 min完成 肌少症定义 低肌力+低肌量 低肌力或低身体功能表现+低肌量 低肌力+体能下降 严重 低肌力+低肌量+低身体功能表现 严重 低肌力+低肌量+低身体功能表现 
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[1] SAYER A A, COOPER R, ARAI H, et al. Sarcopenia[J]. Nat Rev Dis Primers, 2024, 10(1): 68. DOI: 10.1038/s41572-024-00550-w. [2] 于康. 提升肌少症管理水平, 助力健康老龄化进程: 我国在肌少症领域的研究进展和实践探索[J]. 中华临床营养杂志, 2024, 32(5): 257-260.YU K. Improving sarcopenia management and promoting healthy aging: research progress and practical exploration in sarcopenia field in China[J]. Chinese Journal of Clinical Nutrition, 2024, 32(5): 257-260. [3] 吴小雪, 陈鸿桢, 郑坤, 等. 社区老年高血压与肌少症的相关性研究[J]. 中华全科医学, 2024, 22(8): 1371-1375.WU X X, CHEN H Z, ZHENG K, et al. Correlation study of hypertension and sarcopenia in community elderly[J]. Chinese Journal of General Practice, 2024, 22(8): 1371-1375. [4] ALDRICH L, ISPOGLOU T, PROKOPIDIS K, et al. Acute sarcopenia: systematic review and meta-analysis on its incidence and muscle parameter shifts during hospitalisation[J]. J Cachexia Sarcopenia Muscle, 2025, 16(1). DOI: 10.1002/jcsm.13662. [5] MONTERO-ERRASQUÍN B, CRUZ-JENTOFT A J. Acute sarcopenia[J]. Gerontology, 2023, 69(5): 519-525. doi: 10.1159/000529052 [6] SÁEZ DE ASTEASU M L, MARTÍNEZ-VELILLA N, ZAMBOM-FERRARESI F, et al. Short-term multicomponent exercise impact on muscle function and structure in hospitalized older at risk of acute sarcopenia[J]. J Cachexia Sarcopenia Muscle, 2024, 15(6): 2596-2594. [7] KIRK B, CAWTHON P M, ARAI H, et al. The conceptual definition of sarcopenia: delphi consensus from the Global Leadership Initiative in Sarcopenia (GLIS)[J]. Age Ageing, 2024, 53(3). DOI: 10.1093/ageing/afae052. [8] SAYER A A, CRUZ-JENTOFT A. Sarcopenia definition, diagnosis and treatment: consensus is growing[J]. Age Ageing, 2022, 51(10). DOI: 10.1093/ageing/afac220. [9] CRUZ-JENTOFT A J, BAHAT G, BAUER J, et al. Sarcopenia: revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(1): 16-31. doi: 10.1093/ageing/afy169 [10] WELCH C, GREIG C, MAJID Z, et al. Induced frailty and acute sarcopenia are overlapping consequences of hospitalisation in older adults[J]. J Frailty Sarcopenia Falls, 2022, 7(3): 103-116. doi: 10.22540/JFSF-07-103 [11] BERTSCHI D, KISS C M, BEERLI N, et al. Sarcopenia in hospitalized geriatric patients: insights into prevalence and associated parameters using new EWGSOP2 guidelines[J]. Eur J Clin Nutr, 2021, 75(4): 653-660. doi: 10.1038/s41430-020-00780-7 [12] HUANG C H, HSU C C, YU P C, et al. Hospitalization-associated muscle weakness and functional outcomes among oldest old patients: a hospital-based cohort study[J]. Exp Gerontol, 2021, 150: 111353. DOI: 10.1016/j.exger.2021.111353. [13] FLOWER L, PUTHUCHEARY Z. Muscle wasting in the critically ill patient: how to minimise subsequent disability[J]. Br J Hosp Med (Lond), 2020, 81(4): 1-9. [14] YAO Z P, GUO L J, ZHANG L, et al. Transcriptome and metabolome profiling provide new insights into disuse muscle atrophy in chicken: the potential role of fast-twitch muscle fibers[J]. Int J Mol Sci, 2024, 25(6): 3516. DOI: 10.3390/ijms25063516. [15] MIRANDA E R, SHAHTOUT J L, WATANABE S, et al. Muscle-specific Keap1 deletion enhances force production but does not prevent inactivity-induced muscle atrophy in mice[J]. FASEB J, 2025, 39(6). DOI: 10.1096/fj.202402810R. [16] SWASH M, DE CARVALHO M. Intensive care unit-acquired weakness: neuropathology[J]. J Clin Neurophysiol, 2020, 37(3): 197-199. doi: 10.1097/WNP.0000000000000660 [17] DAMANTI S, SENINI E, DE LORENZO R, et al. Acute sarcopenia: mechanisms and management[J]. Nutrients, 2024, 16(20): 3428. DOI: 10.3390/nu16203428. [18] HO J Q, ABRAMOWITZ M K. Clinical consequences of metabolic acidosis-muscle[J]. Adv Chronic Kidney Dis, 2022, 29(4): 395-405. doi: 10.1053/j.ackd.2022.04.010 [19] VAN DYCK L, DERESE I, VANDER PERRE S, et al. OR16-4 The growth hormone axis in relation to muscle weakness in the ICU: effect of early macronutrient deficit[J]. J Endocr Soc, 2019, 3(Supplement_1): 250. [20] KANOVA M, KOHOUT P. Molecular mechanisms underlying intensive care unit-acquired weakness and sarcopenia[J]. Int J Mol Sci, 2022, 23(15). DOI: 10.3390/ijms23158396. [21] ZHONG F, LIANG S, ZHONG Z Y. Emerging role of mitochondrial DNA as a major driver of inflammation and disease progression[J]. Trends Immunol, 2019, 40(12): 1120-1133. doi: 10.1016/j.it.2019.10.008 [22] LEDUC-GAUDET J P, HUSSAIN S N A, BARREIRO E, et al. Mitochondrial dynamics and mitophagy in skeletal muscle health and aging[J]. Int J Mol Sci, 2021, 22(15): 8179. DOI: 10.3390/ijms22158179. [23] CHEN L K, WOO J, ASSANTACHAI P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3): 300-307. e2. doi: 10.1016/j.jamda.2019.12.012 [24] BHASIN S, TRAVISON T G, MANINI T M, et al. Sarcopenia definition: the position statements of the sarcopenia definition and outcomes consortium[J]. J Am Geriatr Soc, 2020, 68(7): 1410-1418. doi: 10.1111/jgs.16372 [25] PANERONI M, SIMONELLI C, SALERI M, et al. Muscle strength and physical performance in patients without previous disabilities recovering from COVID-19 pneumonia[J]. Am J Phys Med Rehabil, 2021, 100(2): 105-109. doi: 10.1097/PHM.0000000000001641 [26] MCAULEY H J C, HARVEY-DUNSTAN T C, CRANER M, et al. Longitudinal changes to quadriceps thickness demonstrate acute sarcopenia following admission to hospital for an exacerbation of chronic respiratory disease[J]. Thorax, 2021, 76(7): 726-728. doi: 10.1136/thoraxjnl-2020-215949 [27] PETERMANN-ROCHA F, DIAZ-TORO F, VALERA-GRAN D, et al. Bibliometric analysis of research on sarcopenic obesity: a review of scientific literature[J]. Obes Rev, 2024, 25(9): e13784. DOI: 10.1111/obr.13784. [28] 陈雅萍, 吕玲娜, 沈琰蕾, 等. 康复运动联合抗阻训练用于肺结节术后患者的效果观察[J]. 中国基层医药, 2024, 31(4): 549-552.CHEN Y P, LYU L N, SHEN Y L, et al. Effect observation of rehabilitation exercise combined with resistance training on patients after lung nodule surgery[J]. Chinese Journal of Primary Medicine and Pharmacy, 2024, 31(4): 549-552. [29] SHEN Y, SHI Q, NONG K, et al. Exercise for sarcopenia in older people: a systematic review and network meta-analysis[J]. J Cachexia Sarcopenia Muscle, 2023, 14(3): 1199-1211. doi: 10.1002/jcsm.13225 [30] CARNEIRO M A S, FRANCO C M C, SILVA A L, et al. Resistance exercise intervention on muscular strength and power, and functional capacity in acute hospitalized older adults: A systematic review and meta-analysis of 2 498 patients in 7 randomized clinical trials[J]. Geroscience, 2021, 43(6): 2693-2705. doi: 10.1007/s11357-021-00446-7 [31] PAROLA V, NEVES H, DUQUE F M, et al. Rehabilitation programs for bedridden patients with prolonged immobility: a scoping review protocol[J]. Int J Environ Res Public Health, 2021, 18(22): 12033. DOI: 10.3390/ijerph182212033. [32] 中国研究型医院学会老年外科专业委员会. 老年外科患者围手术期营养支持中国专家共识(2024版)[J]. 中华消化外科杂志, 2024, 23(5): 629-641.Chinese Research Hospital Association Geriatric Surgery Professional Committee. Expert consensus on perioperative nutritional support for elderly surgical patients in China (2024 edition)[J]. Chinese Journal of Digestive Surgery, 2024, 23(5): 629-641. [33] PROKOPIDIS K, GIANNOS P, KIRWAN R, et al. Impact of probiotics on muscle mass, muscle strength and lean mass: a systematic review and meta-analysis of randomized controlled trials[J]. J Cachexia Sarcopenia Muscle, 2023, 14(1): 30-44. doi: 10.1002/jcsm.13132 [34] GIRON M, THOMAS M, DARDEVET D, et al. Gut microbes and muscle function: can probiotics make our muscles stronger?[J]. J Cachexia Sarcopenia Muscle, 2022, 13(3): 1460-1476. doi: 10.1002/jcsm.12964 [35] FORBES S C, CANDOW D G, OSTOJIC S M, et al. Meta-analysis examining the importance of creatine ingestion strategies on lean tissue mass and strength in older adults[J]. Nutrients, 2021, 13(6): 1912. DOI: 10.3390/nu13061912. [36] GRILLO-ARDILA C F, TIBAVIZCO-PALACIOS D, TRIANA L C, et al. Early enteral nutrition (within 48 h) for patients with sepsis or septic shock: a systematic review and meta-analysis[J]. Nutrients, 2024, 16(11): 1560. DOI: 10.3390/nu16111560. [37] MOON S J, KO R E, PARK C M, et al. The effectiveness of early enteral nutrition on clinical outcomes in critically ill sepsis patients: a systematic review[J]. Nutrients, 2023, 15(14): 3201. DOI: 10.3390/nu15143201. [38] BOULLATA J I, SALMAN G, MIRTALLO J M, et al. Parenteral nutrition compatibility and stability: practical considerations[J]. Nutr Clin Pract, 2024, 39(5): 1150-1163. doi: 10.1002/ncp.11189 [39] LÓPEZ-LÓPEZ L, TORRES-SÁNCHEZ I, RODRÍGUEZ-TORRES J, et al. Does adding an integrated physical therapy and neuromuscular electrical stimulation therapy to standard rehabilitation improve functional outcome in elderly patients with pneumonia? A randomised controlled trial[J]. Clin Rehabil, 2019, 33(11): 1757-1766. doi: 10.1177/0269215519859930 [40] VIEIRA L, SILVA P E, DE MELO P F, et al. Early neuromuscular electrical stimulation preserves muscle size and quality and maintains systemic levels of signaling mediators of muscle growth and inflammation in patients with traumatic brain injury: a randomized clinical trial[J]. Crit Care Res Pract, 2023, 2023: 9335379. DOI: 10.1155/2023/9335379. [41] OTHMAN S Y, ELBIAA M A, MANSOUR E R, et al. Effect of neuromuscular electrical stimulation and early physical activity on ICU-acquired weakness in mechanically ventilated patients: a randomized controlled trial[J]. Nurs Crit Care, 2024, 29(3): 584-596. doi: 10.1111/nicc.13010 [42] MAK R H, GUNTA S, OLIVEIRA E A, et al. Growth hormone improves adipose tissue browning and muscle wasting in mice with chronic kidney disease-associated cachexia[J]. Int J Mol Sci, 2022, 23(23). DOI: 10.3390/ijms232315310. [43] ZHANG Y O, CHEN L, WU P, et al. Intervention with erythropoietin in sarcopenic patients with femoral intertrochanteric fracture and its potential effects on postoperative rehabilitation[J]. Geriatr Gerontol Int, 2020, 20(2): 150-155. doi: 10.1111/ggi.13845 [44] DEER R R, DICKINSON J M, BAILLARGEON J, et al. A Phase I randomized clinical trial of evidence-based, pragmatic interventions to improve functional recovery after hospitalization in geriatric patients[J]. J Gerontol A Biol Sci Med Sci, 2019, 74(10): 1628-1636. doi: 10.1093/gerona/glz084 -
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