肌肉衰减症的动态识解及对我国运动科学研究的启示  

Dynamic Understanding of Sarcopenia and Its Enlightenment to Exercise Science Research in China

作　　者：李海鹏 刘宇[2] LI Haipeng;LIU Yu(Zhejiang University of Technology,Hangzhou 310014,China;Shanghai University of Sport,Shanghai 200438,China)

机构地区：[1]浙江工业大学体育军训部,浙江杭州310014 [2]上海体育学院科学研究院,上海240038

出　　处：《体育科学》2020年第9期61-73,共13页China Sport Science

基　　金：浙江省哲学社会科学规划课题(18NDJC209YB);教育部人文社会科学研究项目(17YJC890012)。

摘　　要：肌肉衰减症已成为公共卫生领域的热点问题之一。30年间,肌肉衰减症的内涵不断演进,经历了“新概念初成—单维度诊断—三维度共识—升级新共识”4个发展阶段,形成了6种国际共识。2019年,欧洲共识(EWGSOP)和亚洲共识(AWGS)又先后将原有共识进行了升级更新。期间,肌肉衰减症入编国际疾病分类表;诊断标准由“肌肉含量单维度”向“肌肉含量、肌肉力量、身体活动能力三维度”转变;三阶段划分从“轻度—中度—重度”改为“可能阳性—确诊阳性—重度阳性”;诊断流程以“F-A-C-S”替代“步速—握力—肌肉含量”;新增SARC-F量表和SarQoL®专用生活质量量表;肌肉力量“前置”;修改诊断指标与诊断阈值等均成为其演进中的代表性事件。升级后的EWGSOP2共识虽同其他共识间的一致性并不理想,但因其弱化了对双能X线吸收检测法的依赖,并对临床后果及3年内死亡率的预测价值较高,在肌肉衰减症临床化进程中具有积极意义。现有介入研究显示,运动是应对肌肉衰减症的有效手段,其中,运动单因素干预时抗阻运动的干预效果已毋庸置疑,但运动联合营养双因素干预效果尚存分歧。建议我国运动科学研究者在动态识解现有共识的基础上,围绕运动干预专家共识、运动干预规范、运动干预标准化以及替代运动方案等议题展开深入研究,以体医融合新模式助力健康中国。As a major public health problem,the connotation of sarcopenia had gone through four developmental stages of“new concept foundation-single dimensional diagnosis-three-dimensional consensus-upgrade new consensus”in the past thirty years,and six international consensuses were released,i.e.,EWGSOP,AWGS,FNIH,IWGS,SSCWD and ESPEN-SIG.The first two consensuses were updated in 2019 and released their new edition named EWGSOP2 and AWGS(2019),respectively.At the same time,sarcopenia was included by the International Classification of Disease(ICD-10-CM)and some modifications were made as follows:the diagnostic criteria changed from“single dimension of muscle mass”to“three dimensions of muscle mass,muscle strength and physical performance”;three stages changed from“pre-sarcopenia-sarcopenia-severe sarcopenia”to“possible sarcopenia-confirmed sarcopenia-severe sarcopenia”;the diagnostic algorithms was replaced“gait speed-handgrip strength-muscle mass”by“F-A-C-S”;the addition of SARC-F scale and SarQoL®questionnaire;emphasized muscle strength dimension;modification for diagnostic index and cut-off points.EWGSOP2 consensus had positive implications for leading sarcopenia to the clinic,due to its reduction on the dependence of DXA detection and its high predictive value for clinical outcomes and 3-year mortality,although its consistency with other consensus was not ideal.Current studies had shown that exercise is an effective method to treat sarcopenia,among which,resistance training was the most effective choice.However,the effect of the combination of exercise and nutrition on sarcopenia treatment was controversial.Thus,it was suggested that our researchers should conduct further research by focusing on the expert consensus,exercise intervention norms,standardization and alternative programs on the basis of dynamic understanding multiple consensus,so as to promote“Healthy China”with the new model of exercise medicine integration.

关 键 词：肌肉衰减症 共识 动态识解 介入研究 运动干预 

分 类 号：G804.2[文化科学—运动人体科学]