个案视角下全科医生基于专家共识的社区肌少症管理思路研究

于溯; 孙艳格; 丁倩; 李晶; 杨玲; 任龙兵; 辛小一

doi:10.16766/j.cnki.issn.1674-4152.004556

个案视角下全科医生基于专家共识的社区肌少症管理思路研究

doi: 10.16766/j.cnki.issn.1674-4152.004556

于溯¹,
孙艳格^1, ,,
丁倩²,
李晶¹,
杨玲¹,
任龙兵³,
辛小一¹

1.
北京市西城区首都医科大学附属复兴医院月坛社区卫生服务中心，北京 100045
2.
北京市大兴区礼贤镇中心卫生院，北京 102604
3.
北京大学医学部公共卫生学院中国卫生发展研究中心，北京 100083

基金项目:

国家自然科学基金青年基金项目 72404010

首都卫生发展科研专项项目首发2022-3-70211

详细信息

通讯作者:
孙艳格，E-mail：13488796993@163.com

中图分类号: R197.1 R592
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- 文章访问数: 8
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- 被引次数: 0
出版历程
- 收稿日期: 2025-02-21
- 网络出版日期: 2026-11-10

A case study on community-based sarcopenia management by general practitioners based on expert consensus

1.
Yuetan Community Health Center, Fuxing Hospital of Capital Medical University, Beijing 100045, China

摘要

摘要: 本文报道1例肌少症患者在社区进行筛查及干预的全过程，将病例与专家共识相结合，为全科医生筛查肌少症患者并进行干预提供思路和借鉴。病例为1例老年女性，在常规骨质疏松症专病门诊就诊过程中，因长期乏力、消瘦，被全科医生留意到是否患有肌少症，进一步检查发现患者握力17.6 kg，四肢骨骼肌质量3.98 kg/m²（生物电阻分析BIA法），明确诊断为肌少症。由上级医院老年科联合我中心全科医生、康复师、营养师共同制定干预方案，包括制定个体化营养干预计划及运动干预处方，对患者进行肌少症社区干预。经过26周干预，患者肌力、肌量、5次起坐试验、6米步速均有提高。目前少数综合医院尝试开展肌少症门诊，基层医院鲜有，本文针对如何能有效地把肌少症防治落实到社区，将肌少症防治窗口前移进行探讨，全科医生可借鉴此案例，帮助有效地开展肌少症筛查、防治工作。
- 肌肉减少症 /
- 营养干预 /
- 运动干预 /
- 社区干预 /
- 全科医生
Abstract: This article describes the complete process of screening and intervention for a patient with sarcopenia in a community setting. By integrating a real-world case with expert consensus, it provides practical insights for general practitioners into the screening and management of sarcopenia. The patient was an elderly female identified during a routine osteoporosis clinic visit who presented with persistent fatigue and unintentional weight loss. Further evaluation revealed a grip strength of 17.6 kg and an appendicular skeletal muscle mass index of 3.98 kg/m², measured via bioelectrical impedance analysis (BIA), confirming a diagnosis of sarcopenia. An interdisciplinary team comprising geriatric specialists from a tertiary hospital, general practitioners, rehabilitation therapists, and nutritionists from our center collaboratively designed an intervention plan that incorporated individualized nutrition and exercise programs for community-based sarcopenia management. After 26 weeks of intervention, improvements were observed in muscle strength, muscle mass, 5-times sit-to-stand test, and 6-meter walking speed. Although some comprehensive hospitals have established sarcopenia clinics, such initiatives remain limited in primary care settings. This article explores feasible strategies for the prevention and management of sarcopenia within communities, emphasizing on early identification and intervention. This findings from this case may assist general practitioners in improving sarcopenia screening, prevention, and treatment practices in community healthcare.
- Sarcopenia /
- Nutritional intervention /
- Exercise intervention /
- Community health service center /
- General practitioners

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图 1 社区肌少症诊疗流程

Figure 1. Diagnosis and treatment pathway for sarcopenia in community healthcare settings

下载: 全尺寸图片幻灯片

表 1 该例患者肌少症评估情况

Table 1. Evaluation of sarcopenia for the patient

项目	肌力(最大握力)	肌量(四肢骨骼肌质量ASMI)	5次起坐试验	SPPB	6米步速
诊断切点	男性＜28 kg，女性＜18 kg	①男性≤7.0 kg/m²，女性≤5.7 kg/m²(生物电阻抗分析BIA法)； ②或男性≤7.0kg/m²，女性≤5.4kg/m²(双能X线吸光仪DXA法)	≥12 s	≤9分	最大歩速＜1.0 m/s
患者情况	17.6 kg	3.98 kg/m²(生物电阻分析BIA法)	8.2 s	12分	0.95 m/s

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表 2 该患者个性化运动干预处方

Table 2. Individualized exercise prescription for the patient

阶段	热身	正式运动	恢复整理
第1个月	拉伸运动5 min	双桥运动10 min，上肢举哑铃运动10 min，下肢弹力带抗阻训练(髋屈曲、外展、后伸)10 min	温和拉伸5 min
第2~4个月	拉伸运动5 min	双桥运动5 min，侧桥运动5 min，空蹬自行车训练5 min，上肢举哑铃训练10 min，下肢弹力带抗阻训练(膝伸展、髋屈曲、外展、后伸)10 min	温和拉伸5 min
第5~6个月	拉伸运动5 min	双桥运动5 min，侧桥运动5 min，空蹬自行车训练5 min，直腿抬高训练5 min，上肢举哑铃训练10 min，下肢弹力带抗阻训练(膝伸展、髋屈曲、外展、后伸)10 min	温和拉伸5 min

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表 3 该患者干预前后体格检查和辅助检查情况

Table 3. Physical and auxiliary examinations before and after intervention for the patient

时间	体重(kg)	BMI	臂中围(cm)	小腿围(cm)	白蛋白(g/L)	血清25羟-维生素D(ng/mL)
基线	45	16.7	21	30	41.1	17.89
26周后	48	18.1	22	30	44.0	13.99

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表 4 该患者干预前后肌少症相关指标情况

Table 4. Sarcopenia-related parameters before and after intervention for the patient

时间	肌力(最大握力)	肌量(四肢骨骼肌质量ASMI)	5次起坐试验	SPPB	6米步速	MNA	Fried衰弱表型
基线	17.6 kg	3.98 kg/m²	8.2 s	12分	0.95 m/s	19.5分	衰弱前期
26周后	18.3 kg	4.34 kg/m²	7.6 s	12分	1.05 m/s	20.0分	无衰弱

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