MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, UK.
Calcif Tissue Int. 2013 Sep;93(3):201-10. doi: 10.1007/s00223-013-9757-z. Epub 2013 Jul 11.
This review provides a framework for the development of an operational definition of sarcopenia and of the potential end points that might be adopted in clinical trials among older adults. While the clinical relevance of sarcopenia is widely recognized, there is currently no universally accepted definition of the disorder. The development of interventions to alter the natural history of sarcopenia also requires consensus on the most appropriate end points for determining outcomes of clinical importance which might be utilized in intervention studies. We review current approaches to the definition of sarcopenia and the methods used for the assessment of various aspects of physical function in older people. The potential end points of muscle mass, muscle strength, muscle power, and muscle fatigue, as well as the relationships between them, are explored with reference to the availability and practicality of the available methods for measuring these end points in clinical trials. Based on current evidence, none of the four potential outcomes in question is sufficiently comprehensive to recommend as a uniform single outcome in randomized clinical trials. We propose that sarcopenia may be optimally defined (for the purposes of clinical trial inclusion criteria as well as epidemiological studies) using a combination of measures of muscle mass and physical performance. The choice of outcome measures for clinical trials in sarcopenia is more difficult; co-primary outcomes, tailored to the specific intervention in question, may be the best way forward in this difficult but clinically important area.
本综述为制定操作性定义的肌少症和可能的终点提供了一个框架，这些终点可能被用于老年人的临床试验中。虽然肌少症的临床相关性已被广泛认可，但目前还没有普遍接受的疾病定义。为改变肌少症的自然病程而开发干预措施，也需要就确定临床重要结果的最合适终点达成共识，这些终点可能被用于干预研究中。我们回顾了目前肌少症定义的方法以及用于评估老年人身体功能各个方面的方法。探讨了肌肉质量、肌肉力量、肌肉功率和肌肉疲劳等潜在终点，以及它们之间的关系，同时参考了这些终点在临床试验中可获得的测量方法的实用性和可用性。基于现有证据，这四个潜在的结果都不够全面，无法推荐作为随机临床试验的统一单一结果。我们提出，肌少症可以通过肌肉质量和身体表现的综合测量来最佳定义（用于临床试验纳入标准和流行病学研究）。在肌少症的临床试验中选择终点更为困难；针对特定干预措施的联合主要终点可能是解决这一困难但具有重要临床意义的领域的最佳方法。
