von Haehling Stephan, Morley John E, Anker Stefan D
J Cachexia Sarcopenia Muscle. 2010 Dec;1(2):129-133. doi: 10.1007/s13539-010-0014-2. Epub 2010 Dec 17.
Human muscle undergoes constant changes. After about age 50, muscle mass decreases at an annual rate of 1-2%. Muscle strength declines by 1.5% between ages 50 and 60 and by 3% thereafter. The reasons for these changes include denervation of motor units and a net conversion of fast type II muscle fibers into slow type I fibers with resulting loss in muscle power necessary for activities of daily living. In addition, lipids are deposited in the muscle, but these changes do not usually lead to a loss in body weight. Once muscle mass in elderly subjects falls below 2 standard deviations of the mean of a young control cohort and the gait speed falls below 0.8 m/s, a clinical diagnosis of sarcopenia can be reached. Assessment of muscle strength using tests such as the short physical performance battery test, the timed get-up-and-go test, or the stair climb power test may also be helpful in establishing the diagnosis. Sarcopenia is one of the four main reasons for loss of muscle mass. On average, it is estimated that 5-13% of elderly people aged 60-70 years are affected by sarcopenia. The numbers increase to 11-50% for those aged 80 or above. Sarcopenia may lead to frailty, but not all patients with sarcopenia are frail-sarcopenia is about twice as common as frailty. Several studies have shown that the risk of falls is significantly elevated in subjects with reduced muscle strength. Treatment of sarcopenia remains challenging, but promising results have been obtained using progressive resistance training, testosterone, estrogens, growth hormone, vitamin D, and angiotensin-converting enzyme inhibitors. Interesting nutritional interventions include high-caloric nutritional supplements and essential amino acids that support muscle fiber synthesis.
人体肌肉会持续发生变化。大约在50岁以后,肌肉质量以每年1%-2%的速度下降。在50岁至60岁之间,肌肉力量下降1.5%,之后每年下降3%。这些变化的原因包括运动单位失神经支配,以及快速型II型肌纤维净转化为慢速型I型纤维,从而导致日常生活活动所需的肌肉力量丧失。此外,脂质会沉积在肌肉中,但这些变化通常不会导致体重减轻。一旦老年受试者的肌肉质量低于年轻对照队列平均值的2个标准差,且步速低于0.8米/秒,即可做出肌肉减少症的临床诊断。使用简短体能状况量表测试、定时起立行走测试或爬楼梯功率测试等方法评估肌肉力量,也可能有助于确诊。肌肉减少症是肌肉质量丧失的四大主要原因之一。据估计,平均而言,60至70岁的老年人中有5%-13%受肌肉减少症影响。80岁及以上人群的这一比例增至11%-50%。肌肉减少症可能导致身体虚弱,但并非所有肌肉减少症患者都身体虚弱——肌肉减少症的发生率约为身体虚弱的两倍。多项研究表明,肌肉力量下降的受试者跌倒风险显著升高。肌肉减少症的治疗仍然具有挑战性,但使用渐进性抗阻训练、睾酮、雌激素、生长激素、维生素D和血管紧张素转换酶抑制剂已取得了有前景的结果。有趣的营养干预措施包括高热量营养补充剂和支持肌纤维合成的必需氨基酸。