Nagano Fumihiko, Yoshimura Yoshihiro, Bise Takahiro, Shimazu Sayuri, Shiraishi Ai
Department of Rehabilitation, Kumamoto Rehabilitation Hospital, Kumamoto, Japan.
Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, 760 Magate, Kikuyo-Town, Kikuchi-County, Kumamoto 869-1106, Japan.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105017. doi: 10.1016/j.jstrokecerebrovasdis.2020.105017. Epub 2020 Jun 16.
Intervention for treating sarcopenia is of great concern in clinical settings. The aim of this study was to investigate the relationship between changes in skeletal muscle mass and functional outcomes in patients with sarcopenia after stroke.
A retrospective cohort study of stroke patients with sarcopenia consecutively admitted to a single center's convalescent rehabilitation wards was conducted from 2015 to 2018. Sarcopenia was defined as a loss of skeletal muscle mass index (SMI) with bioelectrical impedance and decreased muscle strength as measured by handgrip strength; cut-off values were adopted from the 2019 Asian Working Group for Sarcopenia. Changes in SMI during hospitalization were measured. Outcomes included the motor domain of Functional Independence Measure at discharge and its gain. Multivariate analysis determined whether the changes in SMI were associated with these outcomes.
During the study period, 272 stroke patients were enrolled. Of those, 120 patients (44%) (mean age 79 years, 70 females) were diagnosed with sarcopenia. The mean (SD) for changes in SMI was 0.2 (0.5) kg/m. Multiple linear regression analysis showed that changes in SMI were significantly associated with Functional Independence Measure - motor at discharge (β=0.175, P=0.003) and Functional Independence Measure - motor gain (β=0.247, P=0.003).
Muscle mass gain may be positively associated with functional recovery in patients with sarcopenia after stroke. Exercise and nutritional therapy to increase skeletal muscle mass, in addition to conventional stroke rehabilitation, is needed for these patients.
在临床环境中，治疗肌肉减少症的干预措施备受关注。本研究旨在探讨脑卒中后肌肉减少症患者骨骼肌质量变化与功能结局之间的关系。
对2015年至2018年连续入住单一中心康复病房的脑卒中合并肌肉减少症患者进行回顾性队列研究。肌肉减少症的定义为通过生物电阻抗测量的骨骼肌质量指数（SMI）降低，以及通过握力测量的肌肉力量下降；临界值采用2019年亚洲肌肉减少症工作组的标准。测量住院期间SMI的变化。结局指标包括出院时功能独立性测量的运动领域及其改善情况。多变量分析确定SMI的变化是否与这些结局相关。
在研究期间，共纳入272例脑卒中患者。其中，120例患者（44%）（平均年龄79岁，女性70例）被诊断为肌肉减少症。SMI变化的平均值（标准差）为0.2（0.5）kg/m²。多元线性回归分析显示，SMI的变化与出院时功能独立性测量 - 运动领域（β = 0.175，P = 0.003）和功能独立性测量 - 运动改善（β = 0.247，P = 0.003）显著相关。
脑卒中后肌肉减少症患者的肌肉质量增加可能与功能恢复呈正相关。除了传统的脑卒中康复治疗外，这些患者还需要进行运动和营养治疗以增加骨骼肌质量。
