老年肌少症的临床特点与诊断
Clinical Characteristics and Diagnosis of Sarcopenia in the Elderly
DOI: 10.12677/acm.2026.1682854, PDF,   
作者: 韩 笑：重庆医科大学第五临床学院，重庆；何 菲*：重庆医科大学附属永川医院老年医学科，重庆
关键词: 老年肌少症；临床诊断；流行病学特征；共病管理；Senile Sarcopenia； Clinical Diagnosis； Epidemiological Features； Comorbidity Management
摘要: 肌少症是一种与年龄增长相关的进行性骨骼肌疾病，以肌肉质量减少、肌力下降和躯体功能减退为主要特征，在老年人群中患病率高、预后差，尤其常与脑梗死等慢性共病共存，进一步加剧功能障碍和不良健康结局。本文系统综述了肌少症的流行病学特征、病理生理机制、临床表现与分型、诊断标准与工具，特别聚焦于老年脑梗死后肌少症的临床特点与发生机制。脑梗死后由于神经支配中断、活动受限、营养摄入不足及炎症反应等多因素交互作用，肌少症的发生风险显著增高，且与康复预后密切相关。文章还总结了当前诊断中存在的争议与新兴生物标志物研究进展，并展望了未来在分子机制探索、便携式诊断技术及人工智能辅助评估等方面的发展方向，以期为早期识别和综合干预提供理论依据与实践指导。
Abstract: Sarcopenia is an age-related progressive skeletal muscle disorder characterized by reduced muscle mass, decreased strength, and diminished physical function. It is highly prevalent among older adults and often coexists with chronic conditions such as cerebral infarction, leading to worsened functional decline and poor health outcomes. This review summarizes the epidemiological features, pathophysiological mechanisms, clinical manifestations, and diagnostic criteria of sarcopenia, with a particular focus on its clinical characteristics and underlying mechanisms in older patients after cerebral infarction. Post-infarction sarcopenia is influenced by multiple interacting factors including denervation, immobilization, inadequate nutritional intake, and inflammatory responses, which significantly increase its risk and negatively affect rehabilitation prognosis. The article also addresses current diagnostic controversies and recent advances in biomarker research, and suggests future directions for elucidating molecular mechanisms, developing portable diagnostic tools, and incorporating artificial intelligence-assisted evaluation to improve early identification and holistic management of the condition.
文章引用：韩笑, 何菲. 老年肌少症的临床特点与诊断[J]. 临床医学进展, 2026, 16(8): 813-821. https://doi.org/10.12677/acm.2026.1682854

参考文献

[1] Cruz-Jentoft, A.J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., et al. (2018) Sarcopenia: Revised European Consensus on Definition and Diagnosis. Age and Ageing, 48, 16-31.
https://doi.org/10.1093/ageing/afy169
[2] Bauer, J., Morley, J.E., Schols, A.M.W.J., Ferrucci, L., Cruz‐Jentoft, A.J., Dent, E., et al. (2019) Sarcopenia: A Time for Action. an SCWD Position Paper. Journal of Cachexia, Sarcopenia and Muscle, 10, 956-961.
https://doi.org/10.1002/jcsm.12483
[3] 宓雅琪, 张英砾, 罗良涛. 肌少症的研究进展[J]. 中华中医药杂志, 2025, 40(2): 807-810.
[4] 吕芳, 魏雅楠, 林矗, 等. 肌少症荟萃分析概览[J]. 中国医学前沿杂志(电子版), 2022, 14(4): 18-20.
[5] Xia, L., Zhao, R., Wan, Q., Wu, Y., Zhou, Y., Wang, Y., et al. (2020) Sarcopenia and Adverse Health‐Related Outcomes: An Umbrella Review of Meta‐Analyses of Observational Studies. Cancer Medicine, 9, 7964-7978.
https://doi.org/10.1002/cam4.3428
[6] Cruz-Jentoft, A.J. and Sayer, A.A. (2019) Sarcopenia. The Lancet, 393, 2636-2646.
https://doi.org/10.1016/s0140-6736(19)31138-9
[7] Deschenes, M.R., Flannery, R., Hawbaker, A., Patek, L. and Mifsud, M. (2022) Adaptive Remodeling of the Neuromuscular Junction with Aging. Cells, 11, Article 1150.
https://doi.org/10.3390/cells11071150
[8] Moreira-Pais, A., Ferreira, R., Oliveira, P.A. and Duarte, J.A. (2022) A Neuromuscular Perspective of Sarcopenia Pathogenesis: Deciphering the Signaling Pathways Involved. GeroScience, 44, 1199-1213.
https://doi.org/10.1007/s11357-021-00510-2
[9] Damanti, S., Senini, E., De Lorenzo, R., Merolla, A., Santoro, S., Festorazzi, C., et al. (2025) Molecular Constraints of Sarcopenia in the Ageing Muscle. Frontiers in Aging, 6, Article 1588014.
https://doi.org/10.3389/fragi.2025.1588014
[10] Lauretani, F., Maggio, M., Pilotto, A.M., Ansaldo, M., Brusco, C.M., Carbonaro, M., et al. (2025) The Trajectories of Neuromuscular Aging (Trajector‐Age Clinical Trial): Study Rationale and Methodological Protocol. Journal of the American Geriatrics Society, 73, 2819-2827.
https://doi.org/10.1111/jgs.70005
[11] Wu, J., Wang, L., Ervin, J.F., Wang, S.J., Soderblom, E., Ko, D., et al. (2022) GABA Signaling Triggered by TMC-1/Tmc Delays Neuronal Aging by Inhibiting the PKC Pathway in C. Elegans. Science Advances, 8, eadc9236.
https://doi.org/10.1126/sciadv.adc9236
[12] Sztretye, M., Singlár, Z., Balogh, N., Kis, G., Szentesi, P., Angyal, Á., et al. (2020) The Role of Orai1 in Regulating Sarcoplasmic Calcium Release, Mitochondrial Morphology and Function in Myostatin Deficient Skeletal Muscle. Frontiers in Physiology, 11, Article 601090.
https://doi.org/10.3389/fphys.2020.601090
[13] Chai, S., Zhang, N., Cui, C., Bao, Z., Wang, Q., Lin, W., et al. (2025) Systematic Review of Mitochondrial Dysfunction and Oxidative Stress in Aging: A Focus on Neuromuscular Junctions. Neural Regeneration Research, 21, 1947-1960.
https://doi.org/10.4103/nrr.nrr-d-24-01338
[14] Liu, W., Klose, A., Forman, S., Paris, N.D., Wei-LaPierre, L., Cortés-Lopéz, M., et al. (2017) Loss of Adult Skeletal Muscle Stem Cells Drives Age-Related Neuromuscular Junction Degeneration. eLife, 6, e26464.
https://doi.org/10.7554/elife.26464
[15] Cruz-Jentoft, A.J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., et al. (2019) Sarcopenia: Revised European Consensus on Definition and Diagnosis. Age and Ageing, 48, 601.
https://doi.org/10.1093/ageing/afz046
[16] Cruz-Jentoft, A.J., Baeyens, J.P., Bauer, J.M., Boirie, Y., Cederholm, T., Landi, F., et al. (2010) Sarcopenia: European Consensus on Definition and Diagnosis. Age and Ageing, 39, 412-423.
https://doi.org/10.1093/ageing/afq034
[17] Sayer, A.A. and Cruz-Jentoft, A. (2022) Sarcopenia Definition, Diagnosis and Treatment: Consensus Is Growing. Age and Ageing, 51, afac220.
https://doi.org/10.1093/ageing/afac220
[18] Fujishima, I., Fujiu‐Kurachi, M., Arai, H., Hyodo, M., Kagaya, H., Maeda, K., et al. (2019) Sarcopenia and Dysphagia: Position Paper by Four Professional Organizations. Geriatrics & Gerontology International, 19, 91-97.
https://doi.org/10.1111/ggi.13591
[19] Nunes, G.D., Cardenas, L.Z., Miola, T.M., Souza, J.D.O., Carniatto, L.N. and Bitencourt, A.G.V. (2023) Preoperative Evaluation of Sarcopenia in Patients with Colorectal Cancer: A Prospective Study. Revista da Associação Médica Brasileira, 69, 222-227.
https://doi.org/10.1590/1806-9282.20220339
[20] de Sousa, C.R., Victor Coutinho, J.F., Marques, M.B., et al. (2023) Prevalence of Characteristics Associated with Sarcopenia in Elders: A Cross-Sectional Study. Revista Brasileira de Enfermagem, 76, e20220209.
[21] Durlach, O., Tripoz-dit-Masson, S., Massé-Deragon, N., Subtil, F., Niasse-Sy, Z., Herledan, C., et al. (2024) Feasibility of a Screening and Prevention Procedure for Risks Associated with Dysphagia in Older Patients in Geriatric Units: The DYSPHAGING Pilot Study Protocol. BMJ Open, 14, e081333.
https://doi.org/10.1136/bmjopen-2023-081333
[22] Kim, Y.M., Kim, J.H., Baik, S.J., et al. (2011) Association between Skeletal Muscle Attenuation and Gastroesophageal Reflux Disease: A Health Check-Up Cohort Study. Scientific Reports, 9, Article No. 20102.
[23] Lee, D. and Shin, S. (2022) Sarcopenia Is Associated with Metabolic Syndrome in Korean Adults Aged over 50 Years: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 19, Article 1330.
https://doi.org/10.3390/ijerph19031330
[24] Chung, S.M., Hyun, M.H., Lee, E. and Seo, H.S. (2016) Novel Effects of Sarcopenic Osteoarthritis on Metabolic Syndrome, Insulin Resistance, Osteoporosis, and Bone Fracture: The National Survey. Osteoporosis International, 27, 2447-2457.
https://doi.org/10.1007/s00198-016-3548-0
[25] Chen, L., Liu, L., Woo, J., Assantachai, P., Auyeung, T., Bahyah, K.S., et al. (2014) Sarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia. Journal of the American Medical Directors Association, 15, 95-101.
https://doi.org/10.1016/j.jamda.2013.11.025
[26] Chung, J.Y., Kim, S., Kim, S.H. and Park, C.H. (2025) Sarcopenia: How to Determine and Manage. Knee Surgery & Related Research, 37, Article No. 12.
https://doi.org/10.1186/s43019-025-00265-6
[27] Gupta, P., Vu, T., Man, R.E.K., Fenwick, E.K., Tay, L., Yee Sien, N., et al. (2024) The Prevalence Patterns and Risk Factor Profiles of Poor Muscle Health and Its Associated Components in Multiethnic Older Asians: The PIONEER Study. Journal of Cachexia, Sarcopenia and Muscle, 15, 1376-1387.
https://doi.org/10.1002/jcsm.13483
[28] Katsurasako, T., Murata, S., Goda, A., Nakano, H., Shiraiwa, K., Horie, J., et al. (2022) Comparison of Physical Function among Elderly Japanese Women with and without Low Bone Mass and Low Muscle Mass: A Cross-Sectional Study of Older Women Who Engage in Regular Physical Activity. Geriatrics, 7, Article 98.
https://doi.org/10.3390/geriatrics7050098
[29] Kato, T., Ikezoe, T., Tabara, Y., Matsuda, F., Tsuboyama, T. and Ichihashi, N. (2021) Differences in Lower Limb Muscle Strength and Balance Ability between Sarcopenia Stages Depend on Sex in Community-Dwelling Older Adults. Aging Clinical and Experimental Research, 34, 527-534.
https://doi.org/10.1007/s40520-021-01952-6
[30] Yoshida, S., Shiraishi, R., Nakayama, Y. and Taira, Y. (2023) Can Nutrition Contribute to a Reduction in Sarcopenia, Frailty, and Comorbidities in a Super-Aged Society? Nutrients, 15, Article 2991.
https://doi.org/10.3390/nu15132991
[31] Shefflette, A., Patel, N. and Caruso, J. (2023) Mitigating Sarcopenia with Diet and Exercise. International Journal of Environmental Research and Public Health, 20, Article 6652.
https://doi.org/10.3390/ijerph20176652
[32] Arasaki, K., Igarashi, O., Ichikawa, Y., et al. (2006) Reduction in the Motor Unit Number Estimate (MUNE) after Cerebral Infarction. Journal of the Neurological Sciences, 250, 27-32.
[33] Su, Y., Yuki, M. and Otsuki, M. (2020) Prevalence of Stroke-Related Sarcopenia: A Systematic Review and Meta-Analysis. Journal of Stroke and Cerebrovascular Diseases, 29, Article ID: 105092.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105092
[34] Park, J.G., Lee, K.W., Kim, S.B., Lee, J.H. and Kim, Y.H. (2019) Effect of Decreased Skeletal Muscle Index and Hand Grip Strength on Functional Recovery in Subacute Ambulatory Stroke Patients. Annals of Rehabilitation Medicine, 43, 535-543.
https://doi.org/10.5535/arm.2019.43.5.535
[35] 骆晓靖, 胡填, 古剑雄. 脑卒中相关性肌少症的研究进展[J]. 实用心脑肺血管病杂志, 2025, 33(3): 136-140.
[36] 王湾湾, 马清. 肌少症生物标志物的研究进展[J]. 中华老年多器官疾病杂志, 2019, 18(11): 877-880.
[37] 杜红珍, 孙克娟, 李增宁. 肌肉减少症生物标志物研究新进展[J]. 肿瘤代谢与营养电子杂志, 2022, 9(2): 134-140.
[38] 施宏莹, 谢嘉仪, 陈小青, 等. 类风湿关节炎并发肌少症的危险因素分析[J]. 福建医药杂志, 2023, 45(2): 1-4.
[39] 王英慧, 田明, 王越晖. 鸢尾素与骨骼肌线粒体功能及肌少症的关系[J]. 中华老年医学杂志, 2023, 42(7): 872-876.
[40] 景海蓉, 陈雅雯, 付泓博, 等. 肌少症的血清生物标志物[J]. 中华老年多器官疾病杂志, 2022, 21(8): 616-620.
[41] 王师佳, 张玉, 郭嘉羽, 等. 基于生物信息学和机器学习筛选肌少症的生物标志物[J]. 中华临床营养杂志, 2023, 31(6): 321-329.
[42] 赵黄侃, 魏雅楠, 王晶桐. 血细胞炎性指数与肌少症严重程度之间的相关性研究[J]. 中国骨质疏松杂志, 2023, 29(12): 1763-1767+1779.
[43] 杨怡, 董彦杰, 李茜. 围术期诊断肌肉减少症的研究进展[J]. 实用医院临床杂志, 2023, 20(3): 192-196.
[44] 李彩绒, 杨青岩. 肌少症诊断方式的研究进展[J]. 西藏医药, 2022, 43(6): 153-154.
[45] 龚娟芬, 陈昭, 何迎春, 等. 绝经后女性肌肉减少症与代谢危险因子关系研究进展[J]. 浙江中西医结合杂志, 2019, 29(7): 602-605.
[46] Sumukadas, D. (2010) Optimal Management of Sarcopenia. Clinical Interventions in Aging, 5, 217-228.
https://doi.org/10.2147/cia.s11473
[47] Liu, D., Wang, S., Liu, S., Wang, Q., Che, X. and Wu, G. (2024) Frontiers in Sarcopenia: Advancements in Diagnostics, Molecular Mechanisms, and Therapeutic Strategies. Molecular Aspects of Medicine, 97, Article ID: 101270.
https://doi.org/10.1016/j.mam.2024.101270
[48] Han, A., Bokshan, S., Marcaccio, S., DePasse, J. and Daniels, A. (2018) Diagnostic Criteria and Clinical Outcomes in Sarcopenia Research: A Literature Review. Journal of Clinical Medicine, 7, Article 70.
https://doi.org/10.3390/jcm7040070
[49] Huang, L. and Wang, J. (2021) The Therapeutic Intervention of Sex Steroid Hormones for Sarcopenia. Frontiers in Medicine, 8, Article 739251.
https://doi.org/10.3389/fmed.2021.739251
[50] Teixeira, E., Bohn, L., Guimarães, J.P. and Marques-Aleixo, I. (2022) Portable Digital Monitoring System for Sarcopenia Screening and Diagnosis. Geriatrics, 7, Article 121.
https://doi.org/10.3390/geriatrics7060121
[51] Giraudo, C., Cavaliere, A., Lupi, A., Guglielmi, G. and Quaia, E. (2020) Established Paths and New Avenues: A Review of the Main Radiological Techniques for Investigating Sarcopenia. Quantitative Imaging in Medicine and Surgery, 10, 1602-1613.
https://doi.org/10.21037/qims.2019.12.15
[52] Veronesi, F., Salamanna, F., Borsari, V., Ruffilli, A., Faldini, C. and Giavaresi, G. (2024) Unlocking Diagnosis of Sarcopenia: The Role of Circulating Biomarkers—A Clinical Systematic Review. Mechanisms of Ageing and Development, 222, Article ID: 112005.
https://doi.org/10.1016/j.mad.2024.112005
[53] Schütze, K., Schopp, M., Fairchild, T.J. and Needham, M. (2023) Old Muscle, New Tricks: A Clinician Perspective on Sarcopenia and Where to Next. Current Opinion in Neurology, 36, 441-449.
https://doi.org/10.1097/wco.0000000000001185

为你推荐