Department of Physiotherapy, Londrina State University, Londrina, Paraná, Brazil.
Centre of Research and Post-Graduation in Health Sciences (CEPPOS), Londrina State University, Londrina, Paraná, Brazil.
J Cachexia Sarcopenia Muscle. 2020 Oct;11(5):1164-1176. doi: 10.1002/jcsm.12600. Epub 2020 Aug 30.
Sarcopenia prevalence and its clinical impact are reportedly variable in chronic obstructive pulmonary disease (COPD) due partly to definition criteria. This review aimed to identify the criteria used to diagnose sarcopenia and the prevalence and impact of sarcopenia on health outcomes in people with COPD. This review was registered in PROSPERO (CRD42018092576). Five electronic databases were searched to August 2018 to identify studies related to sarcopenia and COPD. Study quality was assessed using validated instruments matched to study designs. Sarcopenia prevalence was determined using authors' definitions. Comparisons were made between people who did and did not have sarcopenia for pulmonary function, exercise capacity, quality of life, muscle strength, gait speed, physical activity levels, inflammation/oxidative stress, and mortality. Twenty-three studies (70% cross-sectional) from Europe (10), Asia (9), and North and South America (4) involving 9637 participants aged ≥40 years were included (69.5% men). Sarcopenia criteria were typically concordant with recommendations of hEuropean and Asian consensus bodies. Overall sarcopenia prevalence varied from 15.5% [95% confidence interval (CI) 11.8-19.1; combined muscle mass, strength, and/or physical performance criteria] to 34% (95%CI 20.6-47.3; muscle mass criteria alone) (P = 0.009 between subgroups) and was greater in people with more severe [37.6% (95%CI 24.8-50.4)] versus less severe [19.1% (95%CI 10.2-28.0)] lung disease (P = 0.020), but similar between men [41.0% (95%CI 26.2-55.9%)] and women [31.9% (95%CI 7.0-56.8%)] (P = 0.538). People with sarcopenia had lower predicted forced expiratory volume in the first second (mean difference -7.1%; 95%CI -9.0 to -5.1%) and poorer exercise tolerance (standardized mean difference -0.8; 95%CI -1.4 to -0.2) and quality of life (standardized mean difference 0.26; 95%CI 0.2-0.4) compared with those who did not (P < 0.001 for all). No clear relationship was observed between sarcopenia and inflammatory or oxidative stress biomarkers. Incident mortality was unreported in the literature. Sarcopenia is prevalent in a significant proportion of people with COPD and negatively impacts upon important clinical outcomes. Opportunities exist to optimize its early detection and management and to evaluate its impact on mortality in this patient group.
据报道，由于定义标准的部分原因，在慢性阻塞性肺疾病（COPD）中，肌少症的患病率及其临床影响存在差异。本综述旨在确定用于诊断肌少症的标准，以及肌少症对 COPD 患者健康结局的患病率和影响。本综述已在 PROSPERO（CRD42018092576）中注册。为了确定与肌少症和 COPD 相关的研究，我们在五个电子数据库中进行了搜索，截至 2018 年 8 月。使用与研究设计相匹配的经过验证的工具来评估研究质量。使用作者的定义来确定肌少症的患病率。比较了有和没有肌少症的人的肺功能、运动能力、生活质量、肌肉力量、步态速度、身体活动水平、炎症/氧化应激和死亡率。来自欧洲（10 项）、亚洲（9 项）和北美和南美（4 项）的 23 项研究（70%为横断面研究）纳入了 9637 名年龄≥40 岁的参与者（69.5%为男性）。肌少症标准通常与欧洲和亚洲共识机构的建议一致。总体肌少症患病率从 15.5%（95%置信区间 11.8-19.1；联合肌肉质量、力量和/或身体表现标准）到 34%（95%置信区间 20.6-47.3；仅肌肉质量标准）不等（亚组间 P=0.009），在更严重的疾病（37.6%（95%置信区间 24.8-50.4））中大于较轻的疾病（19.1%（95%置信区间 10.2-28.0））（P=0.020），但男性（41.0%（95%置信区间 26.2-55.9%））和女性（31.9%（95%置信区间 7.0-56.8%））之间相似（P=0.538）。与没有肌少症的患者相比，肌少症患者的预计第一秒用力呼气量（平均差异-7.1%；95%置信区间-9.0 至-5.1%）和运动耐量（标准化均差-0.8；95%置信区间-1.4 至-0.2）和生活质量（标准化均差 0.26；95%置信区间 0.2-0.4）更差（所有 P<0.001）。目前文献中没有报告肌少症与炎症或氧化应激生物标志物之间的明确关系。发病率死亡率在文献中没有报道。肌少症在相当一部分 COPD 患者中很常见，对重要的临床结局有负面影响。有机会优化其早期检测和管理，并评估其对该患者群体死亡率的影响。
