Fatima Rida, Kim Yonghoon, Baek Suhyeon, Suram Reema Priyanka, An Sun-Joung Leigh, Hong Yonggeun
Department of Rehabilitation Science, Graduate School of Inje University, Gimhae, South Korea.
Biohealth Products Research Center (BPRC), Inje University, Gimhae, South Korea.
J Cachexia Sarcopenia Muscle. 2025 Feb;16(1):e13707. doi: 10.1002/jcsm.13707.
Sarcopenia is a gradual decline in skeletal muscle mass and strength, which eventually leads to reduced physical performance. 50% of people aged 60-80 years suffer from sarcopenia. Considering the devastating outcomes and the importance of promoting healthy ageing, the diagnosis and prevention of sarcopenia is of utmost importance. Recently, C-terminal agrin fragment (CAF) has been identified as an indicator for early diagnosis of sarcopenia. So far, systematic reviews demonstrating CAF as a biomarker for sarcopenia have been conducted, but a meta-analysis is still needed. This study contains systematic review as well as detailed meta-analysis to better understand the association of CAF and sarcopenia.
Articles were primarily obtained from four different databases. Studies demonstrating the association between CAF and sarcopenia were selected. Data extraction and analysis were performed using STATASE 16 software. The risk of bias and quality assessment of each study was carried out using Joanna Briggs Institute (JBI) Critical Appraisal Tool. Meta-regression, subgroup and sensitivity analysis were conducted to identify the source of heterogeneity.
Seventeen studies were included in the qualitative analysis, out of which 10 were included in the quantitative analysis. The meta-analysis showed that CAF levels were significantly higher in sarcopenia patients, with an effect size of 1.93 (ROM = 1.93, 95% CI [1.49 to 2.36]; p = 0.00) and 1.38 (ROM = 1.38, 95% CI [0.94 to 1.83], p = 0.00) when compared with non-sarcopenic and non-sarcopenic (other co-morbidities) group, respectively. CAF levels were also negatively associated with hand grip strength (HGS) and skeletal muscle index (SMI) with an effect size of 1.09 (ROM = 1.09 with 95% CI [1.05 to 1.13], p = 0.00) and 1.10 (ROM = 1.10 with 95% CI [1.05 to 1.14], p = 0.00), respectively. Meta-regression and subgroup analysis revealed that although sarcopenia is associated with increasing age, the correlation between CAF and age was statistically insignificant (p = 0.44), suggesting that the variation of age among sarcopenia patients could be source of heterogeneity among studies. All the studies included in the meta-analysis reported low risk of bias.
Our meta-analysis concluded that elevated CAF levels were associated with sarcopenia and decreased HGS and SMI. CAF could serve as a valuable marker for the early detection and monitoring of sarcopenia, ultimately facilitating the management and treatment of this debilitating condition.
肌肉减少症是骨骼肌质量和力量的逐渐下降，最终导致身体机能下降。60至80岁的人群中有50%患有肌肉减少症。鉴于其严重后果以及促进健康老龄化的重要性，肌肉减少症的诊断和预防至关重要。最近，C端集聚蛋白片段（CAF）已被确定为肌肉减少症早期诊断的一个指标。到目前为止，已经有关于CAF作为肌肉减少症生物标志物的系统评价，但仍需要进行荟萃分析。本研究包含系统评价以及详细的荟萃分析，以更好地了解CAF与肌肉减少症之间的关联。
文章主要从四个不同的数据库中获取。选择了证明CAF与肌肉减少症之间存在关联的研究。使用STATASE 16软件进行数据提取和分析。使用乔安娜·布里格斯研究所（JBI）批判性评价工具对每项研究的偏倚风险和质量进行评估。进行荟萃回归、亚组分析和敏感性分析以确定异质性的来源。
定性分析纳入了17项研究，其中10项纳入了定量分析。荟萃分析表明，肌肉减少症患者的CAF水平显著更高，与非肌肉减少症患者和非肌肉减少症（伴有其他合并症）组相比，效应量分别为1.93（比值比[ROM]=1.93，95%置信区间[CI][1.49至2.36]；p=0.00）和1.38（ROM=1.38，95%CI[0.94至1.83]，p=0.00）。CAF水平也与握力（HGS）和骨骼肌指数（SMI）呈负相关，效应量分别为1.09（ROM=1.09，95%CI[1.05至1.13]，p=0.00）和1.10（ROM=1.10，95%CI[1.05至1.14]，p=0.00）。荟萃回归和亚组分析显示，虽然肌肉减少症与年龄增长有关，但CAF与年龄之间的相关性在统计学上不显著（p=0.44），这表明肌肉减少症患者年龄的差异可能是研究间异质性的来源。荟萃分析中纳入的所有研究报告的偏倚风险都很低。
我们的荟萃分析得出结论，CAF水平升高与肌肉减少症以及HGS和SMI降低有关。CAF可作为肌肉减少症早期检测和监测的有价值标志物，最终有助于对这种使人衰弱的疾病进行管理和治疗。
