肌肉衰减症发病机制研究进展及其对临床诊断的指导意义

Progress in pathogenesis research of sarcopenia and its guidance for clinical diagnosis

社会快速老龄化过程中,肌肉衰减症(sarcopenia)现患率呈现明显增高趋势,已成为威胁全民健康、降低生活质量和消耗医疗资源的重大公共健康问题和社会经济问题.欧洲(EWGSOP)和亚洲(AWGS)肌肉衰减症工作组对其诊断路径和标准进行了多次修订,在最新指南中将肌肉力量作为诊断可能肌肉衰减症的重要指标.肌肉衰减症发病机制尚不明确,影响了精准化防治策略的制定和实施.目前认为,老龄化过程中肠道微生态环境变化是导致肌肉衰减的重要基础;而静态活动方式和高脂肪膳食可致慢性炎症环境和胰岛素抵抗,成为肌肉衰减症发生发展的中心环节.本文检索了国内外关于肌肉衰减症的最新流行病学和机制研究,分析导致肌肉衰减症发生的分子基础及目前对于肌肉衰减症筛查、评估和诊断的标准化流程,以期为制定精准化防治策略提供参考.

The rapidly aging population of China and the increasing prevalence of sarcopenia have become a major public health problem that threatens public health,reduces the quality of life,and consumes large amounts of medical resources.The European(EWGSOP)and Asian(AWGS)working groups on sarcopenia have revised the diagnostic pathway several times.In the latest version of the diagnostic guidelines(EWGSOP2),muscle strength(grip strength)was indicated as an important tool for the diagnosis of possible sarcopenia.Because the pathogenic mechanism remains unclear,the development of prevention and treatment strategies has been slow and difficult.At present,it is believed that the change of gut microbe environment is an important basis for sarcopenia during aging,and a sedentary lifestyle and high-fat diet can cause chronic inflammatory environment and insulin resistance,which become the central link of the occurrence and development of sarcopenia.Our review outlines current knowledge concerning the possible mechanism of sarcopenia and epidemiology to analyze the molecular basis of sarcopenia and evaluate the current standardized process for screening,evaluation,and diagnosis of sarcopenia,to provide reference for formulating precise prevention and control strategies.