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亚洲恶病质的诊断与转归:亚洲恶病质工作组共识报告

Diagnosis and outcomes of cachexia in Asia: Working Consensus Report from the Asian Working Group for Cachexia.

作者信息

Arai Hidenori, Maeda Keisuke, Wakabayashi Hidetaka, Naito Tateaki, Konishi Masaaki, Assantachai Prasert, Auyeung Wai Tung, Chalermsri Chalobol, Chen Wei, Chew Justin, Chou Ming-Yueh, Hsu Chih-Cheng, Hum Allyn, Hwang In Gyu, Kaido Toshimi, Kang Lin, Kamaruzzaman Shahrul Bahyah, Kim Miji, Lee Jenny Shun Wah, Lee Wei-Ju, Liang Chih-Kuang, Lim Wee Shiong, Lim Jae-Young, Lim Yen Peng, Lo Raymond See-Kit, Ong Terence, Pan Wen-Harn, Peng Li-Ning, Pramyothin Pornpoj, Razalli Nurul Huda, Saitoh Masakazu, Shahar Suzana, Shi Han Ping, Tung Heng-Hsin, Uezono Yasuhito, von Haehling Stephan, Won Chang Won, Woo Jean, Chen Liang-Kung

机构信息

National Center for Geriatrics and Gerontology, Obu, Japan.

Nutrition Therapy Support Center, Aichi Medical University Hospital, Nagakute, Japan.

出版信息

J Cachexia Sarcopenia Muscle. 2023 Oct;14(5):1949-1958. doi: 10.1002/jcsm.13323. Epub 2023 Sep 5.

Abstract

Chronic diseases often lead to metabolic disorders, causing anabolic resistance and increased energy consumption, which result in cachexia. Cachexia, in turn, can lead to major clinical consequences such as impaired quality of life, shortened life expectancy, and increased healthcare expenditure. Existing international diagnostic criteria for cachexia employ thresholds derived from Western populations, which may not apply to Asians due to differing body compositions. To address this issue, the Asian Working Group for Cachexia (AWGC) was initiated. The AWGC comprises experts in cachexia research and clinical practice from various Asian countries and aims to develop a consensus on diagnostic criteria and significant clinical outcomes for cachexia in Asia. The AWGC, composed of experts in cachexia research and clinical practice from several Asian countries, undertook three-round Delphi surveys and five meetings to reach a consensus. Discussions were held on etiological diseases, essential diagnostic items for cachexia, including subjective and objective symptoms and biomarkers, and significant clinical outcomes. The consensus highlighted the importance of multiple diagnostic factors for cachexia, including chronic diseases, either or both weight loss or low body mass index, and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>5 mg/L [0.5 mg/dL]). The AWGC proposed a significant weight change of 2% or more over a 3-6 month period and suggested a tentative cut-off value of 21 kg/m for low body mass index in diagnosing cachexia. Critical clinical outcomes were determined to be mortality, quality of life as assessed by tools such as EQ-5D or the Functional Assessment of Anorexia/Cachexia Therapy, and functional status as measured by the Clinical Frailty Scale or Barthel Index, with significant emphasis on patient-reported outcomes. The AWGC consensus offers a comprehensive definition and user-friendly diagnostic criteria for cachexia, tailored specifically for Asian populations. This consensus is set to stimulate future research and enhance the multidisciplinary approach to managing cachexia. With plans to develop further guidelines for the optimal treatment, prevention, and care of cachexia in Asians, the AWGC criteria are expected to drive research across chronic co-morbidities and cancer in Asia, leading to future refinement of diagnostic criteria.

摘要

慢性病常导致代谢紊乱,引起合成代谢抵抗和能量消耗增加,进而导致恶病质。恶病质反过来又会导致严重的临床后果,如生活质量受损、预期寿命缩短和医疗费用增加。现有的恶病质国际诊断标准采用的阈值源自西方人群,由于身体组成不同,可能不适用于亚洲人。为解决这一问题,亚洲恶病质工作组(AWGC)成立。AWGC由来自亚洲各国的恶病质研究和临床实践专家组成,旨在就亚洲恶病质的诊断标准和重大临床结局达成共识。由来自几个亚洲国家的恶病质研究和临床实践专家组成的AWGC进行了三轮德尔菲调查和五次会议以达成共识。会议就病因性疾病、恶病质的基本诊断项目(包括主观和客观症状及生物标志物)以及重大临床结局展开了讨论。共识强调了恶病质多种诊断因素的重要性,包括慢性病、体重减轻或低体重指数(二者其一或兼具),以及以下至少一项:厌食、握力下降(男性<28 kg,女性<18 kg)或C反应蛋白水平升高(>5 mg/L [0.5 mg/dL])。AWGC提出在3至6个月内体重显著变化2%或更多,并建议在诊断恶病质时低体重指数的暂定临界值为21 kg/m²。关键临床结局确定为死亡率、通过EQ-5D或厌食/恶病质治疗功能评估等工具评估的生活质量,以及通过临床衰弱量表或巴氏指数测量的功能状态,其中特别强调患者报告的结局。AWGC共识为恶病质提供了全面的定义和用户友好的诊断标准,专门针对亚洲人群量身定制。这一共识将激发未来的研究,并加强管理恶病质的多学科方法。随着计划为亚洲人制定关于恶病质的最佳治疗、预防和护理的进一步指南,AWGC标准有望推动亚洲针对慢性共病和癌症的研究,从而促使未来诊断标准的完善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b214/10570088/fa77c8fbe3fb/JCSM-14-1949-g001.jpg

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