前言 40 8% 70 15% [1] 40 10-15% 70 25-40% [2] 定義 1989 Irwin Rosenberg 台中慈濟醫院家庭醫學科 sarcopenia, pathophysiology, treatment (Sarcopenia) (European Working Group on Sarcopenia in Older People, EWGSOP) 2010 (low muscle mass) (low muscle strength) (low physical performance) [3] (primary) (secondary) [3] ( deconditioning) ( ) ( ) (geriatric syndrome) 103
( ) [3] 流行病學 60 70 5%-13% 80 11%-50% [4] 65 3.9%-7.3% ( 2.5%-6.5% 5.4%-8.2%) [5] 評估與測量方法 [3] 1. X (Dual energy X-ray absorptionmetry, DXA) (Bio-impedance analysis, BIA) (appendicular skeletal muscle mass index) (appendicular skeletal muscle mass/ squared height, ASM/ht 2 ) ASM/ht 2 20% 6.76 kg/m 2 5.28 kg/m 2 7.09 kg/m 2 5.70 kg/m 2 [5] 2. ( ) (handgrip strength) (knee flextion/extension) (peak expiratory flow) 20% [5] 3. (usual gait speed) (short physical performance battery, SPPB) 65 0.8 (6-min walk test) (stair climb power test) 臨床篩檢 65 0.8 ( ) [3] 病生理機轉 104
表一手部握力 : 以研究族群最低之 20% 值為切點 男性 BMI <22.1 kg/ m 2 25.0 kg protein (CRP) (4) (5) BMI 22.1 24.3 kg/ m 2 BMI 24.4 26.3 kg/ m 2 26.5 kg 26.4 kg 肌少症對健康的影響 BMI >26.3 kg/ m 2 27.2 kg 女性 BMI <22.3 kg/ m 2 14.6 kg BMI 22.3 24.2 kg/ m 2 16.1 kg BMI 24.3 26.8 kg/ m 2 16.5 kg BMI >26.8 kg/ m 2 16.4 kg 資料來源 : 參考資料 5 [2,3] (1) (2) (growth hormone) Insulin-like growth factor 1 (IGF-1) (androgen) (estrogen) (anabolism) (catabolism) D (25-OH Vitamin D) (3) (tumor necrosis factor-alpha, TNF- ) interleukin (IL)-6, IL-1 C-reactive (1) (2) [6] (3) (sarcopenic obesity, sarcopesity ) 預防與治療 1.2-1.5 105
圖一肌少症臨床篩檢 資料來源 : 參考資料 3 25-30 [7] (leucine) [7] D D hydroxylation D D3 (1,25-dihydroxyvitamin D3; calcitriol) D D (<30 ng/ml) [7] 2007 [8] ( ) 106
5 10 60 10 3 2 48 20~30 [8] (testosterone) [9, 10] Selective androgen receptor modulators (SARM) (growth hormone) Ghrelin Mimetics angiotensin-converting enzyme inhibitor (ACEI) [9] 結論 參考資料 1. Grimby G, Saltin B: The ageing muscle. Clin Physiol 1983; 3: 209-18. 2. Tae Nyun Kim, Kyung Mook Choi. Sarcopenia: Definition, Epidermiology, and Pathophsiology. J Bone Metab 2013; 20:1-10. 3. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al: Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and ageing 2010; 39: 412-23. 4. von Haehling S, MorleyJE, Anker SD: An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle 2010; 1:129-33. 5. Wu IC, Lin CC, Hsiung CA et al: Epidemiology of sarcopenia among community-dwelling older adults in Taiwan: A pooled analysis for a broader adoption of sarcopenia assessments. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 52-60. 6. Moon SS: Low skeletal muscle mass is associated with insulin resistance, diabetes, and metabolic syndrome in the Korean population: the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2010. Endocr J. 2014; 61:61-70. 7. Waters DL, Baumgartner RN, Garry PJ et al: Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. Clinical Interventions in Aging 2010; 5: 259-270. 8. 2009 24 8-13 9. Ali S, Garcia JM: Sarcopenia, Cachexia and Aging: Diagnosis, Mechanisms and Therapeutic Options A Mini-Review. Gerontol 2014; 60: 294-305. 10. 2013 71 50-54 107