切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2026, Vol. 12 ›› Issue (01) : 102 -108. doi: 10.3877/cma.j.issn.2096-1537.2026.01.015

综述

重症患者肌肉减少症评估方法的研究进展
陈湘锭, 任衍康, 张文辉, 左祥荣, 曹权()   
  1. 210029 南京,南京医科大学第一附属医院重症医学科
  • 收稿日期:2024-05-07 出版日期:2026-02-28
  • 通信作者: 曹权
  • 基金资助:
    江苏省333人才工程项目(2022-3-25-045); 江苏省青年医学人才项目(QNRC2016557); 江苏省高层次卫生人才“六个一工程”拔尖人才工程项目(LGY2019067)

Research update on evaluation methods of sarcopenia in critically ill patients

Xiangding Chen, Yankang Ren, Wenhui Zhang, Xiangrong Zuo, Quan Cao()   

  1. Department of Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2024-05-07 Published:2026-02-28
  • Corresponding author: Quan Cao
引用本文:

陈湘锭, 任衍康, 张文辉, 左祥荣, 曹权. 重症患者肌肉减少症评估方法的研究进展[J/OL]. 中华重症医学电子杂志, 2026, 12(01): 102-108.

Xiangding Chen, Yankang Ren, Wenhui Zhang, Xiangrong Zuo, Quan Cao. Research update on evaluation methods of sarcopenia in critically ill patients[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2026, 12(01): 102-108.

肌肉减少症,简称肌少症,是以骨骼肌质量、力量逐渐全面丧失为特征的病症,有诸多不良的临床结局。肌少症在ICU患者中非常普遍,常导致多种不良预后,已逐渐引起ICU医师的重视。肌少症可实现的评估方法包括肌力测量、体能表现评估和肌肉数量或质量的测量。肌力测量和体能表现评估在ICU患者中可行性太小,故对重症患者进行肌少症评估时,多测量肌肉的数量或质量,目前主要的评估方法包括双能X射线(DXA)、生物电阻抗分析(BIA)、CT、磁共振(MRI)、超声(US)、肌少症指数(SI)等,每个方法各有其特点,对于重症患者来说,也各有其优劣势。本文就相关研究作一综述,以期为重症患者的肌少症临床评估和科学研究提供参考。

Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, leading to numerous adverse clinical consequences. It is particularly prevalent among ICU patients, often resulting in various poor prognoses, which has gradually garnered the attention of ICU physicians. The assessment methods for sarcopenia include muscle strength measurement, physical performance evaluation, and the measurement of muscle quantity or quality. Given the limited feasibility of muscle strength measurement and physical performance in critically ill patients, the assessment of sarcopenia in critically ill patients primarily focuses on measuring muscle mass or quantity. Various methods can be employed, including dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), sarcopenia index (SI), and other techniques. Each method has its own characteristics, advantages and disadvantages for critically ill patients. We aims to provide necessary references for the clinical evaluation and scientific research of sarcopenia in critically ill patients.

表1 ICU肌少症各项评估技术的比较
1
Rosenberg IH. Sarcopenia: origins and clinical relevance [J]. J Nutr, 1997, 127(5 Suppl): 990s-991s.
2
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [J]. Age Ageing, 2019, 48(1): 16-31.
3
Cleymaet R, D'ondt M, Scheinok T, et al. Comparison of bioelectrical impedance analysis (BIA)-derived parameters in healthy volunteers and critically ill patients [J]. Life (Basel), 2023, 14(1): 27.
4
Lambell KJ, King SJ, Forsyth AK, et al. Association of energy and protein delivery on skeletal muscle mass changes in critically ill adults: a systematic review [J]. JPEN J Parenter Enteral Nutr, 2018, 42(7): 1112-1122.
5
谢芳, 潘世琴, 孙丽娟, 等. ICU患者双上肢握力及髋关节屈曲拉力水平及其影响因素 [J/OL]. 中华重症医学电子杂志, 2021, 7(3): 228-232.
6
Kou HW, Yeh CH, Tsai HI, et al. Sarcopenia is an effective predictor of difficult-to-wean and mortality among critically ill surgical patients [J]. PLoS One, 2019, 14(8): e0220699.
7
刘娟, 丁清清, 周白瑜, 等. 中国老年人肌少症诊疗专家共识 (2021) [J]. 中华老年医学杂志, 2021, 40(8): 943-952.
8
Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment [J]. J Am Med Dir Assoc, 2020, 21(3): 300-307.e2.
9
Cruz-Jentoft AJ, Sayer AA. Sarcopenia [J]. Lancet (London, England), 2019, 393(10191): 2636-2646.
10
Lester RM, Ghatas MP, Khan RM, et al. Prediction of thigh skeletal muscle mass using dual energy x-ray absorptiometry compared to magnetic resonance imaging after spinal cord injury [J]. J Spinal Cord Med, 2019, 42(5): 622-630.
11
Dent E, Morley JE, Cruz-Jentoft AJ, et al. International clinical practice guidelines for sarcopenia (icfsr): screening, diagnosis and management [J]. J Nutr Health Aging, 2018, 22(10): 1148-1161.
12
Studenski SA, Peters KW, Alley DE, et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates [J]. J Gerontol A Biol Sci Med Sci, 2014, 69(5): 547-558.
13
Thackeray M, Mohebbi M, Orford N, et al. Lean mass as a risk factor for intensive care unit admission: an observational study [J]. Critical care (London, England), 2021, 25(1): 364.
14
Schweighofer N, Colantonio C, Haudum CW, et al. DXA-Derived Indices in the Characterisation of Sarcopenia [J]. Nutrients, 2021, 14(1):186.
15
Rush B, Binkley N, Krueger D, et al. Combination of DXA and BIS predicts jump power better than traditional measures of sarcopenia [J]. JBMR plus, 2021, 5(8): e10527.
16
Looijaard W, Staoel SN, Dekker IM, et al. Identifying critically ill patients with low muscle mass: Agreement between bioelectrical impedance analysis and computed tomography [J]. Clin Nutr, 2020, 39(6): 1809-1817.
17
Deana C, Gunst J, Derosa S, et al. Bioimpedance-assessed muscle wasting and its relation to nutritional intake during the first week of ICU: a pre-planned secondary analysis of nutriti study [J]. Ann Intensive Care, 2024, 14(1): 29.
18
Vongchaiudomchoke W, Sathitkarnmanee B, Thanakiattiwibun C, et al. The association between sarcopenia and functional outcomes after hospital discharge among critically ill surgical patients [J]. Asian J Surg, 2022, 45(7): 1408-1413.
19
Jang A, Bae CH, Han SJ, et al. Association between length of stay in the intensive care unit and sarcopenia among hemiplegic stroke patients [J]. Ann Rehabil Med, 2021, 45(1): 49-56.
20
Han A, Bokshan SL, Marcaccio SE, et al. Diagnostic criteria and clinical outcomes in sarcopenia research: a literature review [J]. J Clin Med, 2018, 7(4): 70.
21
Kubiak CA, Ranganatha K, Matusko N, et al. Computed tomography evidence of psoas muscle atrophy without concomitant tendon wasting in early sepsis [J]. J Surg Res, 2019, 234: 210-216.
22
Tapper EB, Zhang P, Garg R, et al. Body composition predicts mortality and decompensation in compensated cirrhosis patients: a prospective cohort study [J]. JHEP Rep, 2020, 2(1): 100061.
23
Bahat G, Turkmen BO, Aliyev S, et al. Cut-off values of skeletal muscle index and psoas muscle index at L3 vertebra level by computerized tomography to assess low muscle mass [J]. Clin Nutr, 2021, 40(6): 4360-4365.
24
Zeng X, Shi ZW, Yu JJ, et al. Sarcopenia as a prognostic predictor of liver cirrhosis: a multicentre study in China [J]. J Cachexia Sarcopenia Muscle, 2021, 12(6): 1948-1958.
25
Derstine BA, Holcombe SA, Ross BE, et al. Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population [J]. Sci Rep, 2018, 8(1): 11369.
26
Giraudo C, Librizzi G, Fichera G, et al. Reduced muscle mass as predictor of intensive care unit hospitalization in COVID-19 patients [J]. PLoS One, 2021, 16(6): e0253433.
27
Herault A, Lévêque E, Draye-Carbonnier S, et al. High prevalence of pre-existing sarcopenia in critically ill patients with hematologic malignancies admitted to the intensive care unit for sepsis or septic shock [J]. Clin Nutr ESPEN, 2023, 55: 373-383.
28
Moon SW, Kim SY, Choi JS, et al. Thoracic skeletal muscle quantification using computed tomography and prognosis of elderly ICU patients [J]. Sci Rep, 2021, 11(1): 23461.
29
Damanti S, Cristel G, Ramirez GA, et al. Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients [J]. Clin Nutr, 2022, 41(12): 2965-2972.
30
Baggerman MR, Van Dijk DPJ, Winkens B, et al. Edema in critically ill patients leads to overestimation of skeletal muscle mass measurements using computed tomography scans [J]. Nutrition, 2021, 89: 111238.
31
Albano D, Messina E C, Vitale J, et al. Imaging of sarcopenia: old evidence and new insights [J]. Eur Radiol, 2020, 30(4): 2199-2208.
32
Otsuka Y, Yamada Y, Maeda A, et al. Effects of resistance training intensity on muscle quantity/quality in middle-aged and older people: a randomized controlled trial [J]. J Cachexia Sarcopenia Muscle, 2022, 13(2): 894-908.
33
Pernik MN, Hicks WH, Akbik OS, et al. Psoas muscle index as a predictor of perioperative outcomes in geriatric patients undergoing spine surgery [J]. Global Spine J., 2023, 13(7): 2016-2024.
34
Bury C, Dechicco R, Nowak D, et al. Use of bedside ultrasound to assess muscle changes in the critically ill surgical patient [J]. JPEN J Parenter Enteral Nutr, 2021, 45(2): 394-402.
35
Nies I, Ackermans L, Poeze M, et al. The diagnostic value of ultrasound of the rectus femoris for the diagnosis of sarcopenia in adults: a systematic review [J]. Injury, 2022, 53(Suppl 3): S23-S9.
36
Rodrigues CN, Ribeiro Henrique J, Ferreira ARS, et al. Ultrasonography and other nutrition assessment methods to monitor the nutrition status of critically ill patients [J]. JPEN J Parenter Enteral Nutr, 2021, 45(5): 982-990.
37
Narici M, Mcphee J, Conte M, et al. Age-related alterations in muscle architecture are a signature of sarcopenia: the ultrasound sarcopenia index [J]. J Cachexia Sarcopenia Muscle, 2021, 12(4): 973-982.
38
Nakaishi N, Tsutsumi R, Okayama Y, et al. Monitoring of muscle mass in critically ill patients: comparison of ultrasound and two bioelectrical impedance analysis devices [J]. J Intensive Care, 2019, 7: 61.
39
Gould DW, Watson EL, Wilkinson TJ, et al. Ultrasound assessment of muscle mass in response to exercise training in chronic kidney disease: a comparison with MRI [J]. J Cachexia Sarcopenia Muscle, 2019, 10(4): 748-755.
40
Yanagi N, Koike T, Kamiya K, et al. Assessment of sarcopenia in the intensive care unit and 1-year mortality in survivors of critical illness [J]. Nutrients, 2021, 13(8): 2726.
41
Er B, Mızrak B, Aaydemir A, et al. Association of nutritional status, frailty, and rectus femoris muscle thickness measured by ultrasound and weaning in critically ill elderly patients [J]. Tuber Toraks, 2023, 71(1): 1-6.
42
Buitrago NDC, Gallego DT, Pérez MCF, et al. Assessment of quadriceps muscle mass by ultrasound in the postoperative period of cardiac surgery [J]. Ultrasound J, 2024, 16(1): 8.
43
Özdemir U, Özdemir M, Aygencel G, et al. The role of maximum compressed thickness of the quadriceps femoris muscle measured by ultrasonography in assessing nutritional risk in critically-ill patients with different volume statuses [J]. Rev Assoc Med Bras, 2019, 65(7): 952-958.
44
Perkisas S, Baudry S, Bauer J, et al. The SARCUS project: evidence-based muscle assessment through ultrasound [J]. Eur Geriatr Med, 2019, 10(1): 157-158.
45
Perkisas S, Baudry S, Bauer J, et al. Application of ultrasound for muscle assessment in sarcopenia: towards standardized measurements [J]. Eur Geriatr Med, 2018, 9(6): 739-957.
46
Dams K, De Meyer GR, Jacobs R, et al. Combined ultrasound of m. quadriceps and diaphragm to determine the occurrence of sarcopenia and prolonged ventilation in a COVID-19 ICU cohort: the COVID-SARCUS trial [J]. Nutrition, 2024, 117: 112250.
47
Fu H, Wang L, Zhang W, et al. Diagnostic test accuracy of ultrasound for sarcopenia diagnosis: a systematic review and meta-analysis [J]. Journal of cachexia, sarcopenia and muscle, 2023, 14(1): 57-70.
48
Kashani KB, Frazee EN, Kukralova L, et al. Evaluating muscle mass by using markers of kidney function: development of the sarcopenia index [J]. Crit Care Med, 2017, 45(1): e23-e29.
49
Yang J, Zhang T, Feng D, et al. A new diagnostic index for sarcopenia and its association with short-term postoperative complications in patients undergoing surgery for colorectal cancer [J]. Colorectal Dis, 2019, 21(5): 538-547.
50
Barreto EF, Poyan JO, Coville HH, et al. Validation of the sarcopenia index to assess muscle mass in the critically ill: a novel application of kidney function markers [J]. Clin Nutr, 2019, 38(3): 1362-1367.
51
Barreto EF, Kanderi T, Dicecco SR, et al. Sarcopenia index is a simple objective screening tool for malnutrition in the critically ill [J]. JPEN J Parenter Enteral Nutr, 2019, 43(6): 780-788.
[1] 莫遵玉, 赖莉萍, 李水平, 葛肖艳. 基于多种超声参数构建乳腺癌高负荷腋窝淋巴结转移的预测模型[J/OL]. 中华乳腺病杂志(电子版), 2026, 20(02): 82-90.
[2] 黎钰敏, 朱晓旭, 陈子昂, 谢晓娜, 张金丽, 张志. 高频超声联合剪切波弹性成像在增生性瘢痕厚度与硬度评估中的应用价值[J/OL]. 中华损伤与修复杂志(电子版), 2026, 21(02): 90-96.
[3] 杨国涛, 毛华杰, 陈志军, 陈金亮, 车军, 江起庭. 超声辅助定位经皮通道松解对慢性腕管综合征的临床疗效分析[J/OL]. 中华损伤与修复杂志(电子版), 2026, 21(02): 97-101.
[4] 孔博, 张璟, 于双妮, 孝梦甦, 齐振红, 吕珂. 腹壁型侵袭性纤维瘤病的超声特征[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(01): 15-18.
[5] 张亚琼, 李香, 唐芳芳, 曹治平, 雷斌, 马宇宇. 基于多层螺旋CT影像学特征与高频超声鉴别成人腹股沟斜疝、直疝的临床价值[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(01): 19-25.
[6] 谢本发, 牛居辉, 韩苗华, 何睿, 张庆兵, 许伟. 超声引导前、后路腰方肌阻滞对腹股沟疝修补术后镇痛效果的比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(01): 58-61.
[7] 东小鸽, 樊海宁, 侯立朝, 杜凯豪, 刘海刚, 汪占金, 薛伟伟, 石亚超, 魏六木, 王展. 三维可视化技术、ICG荧光示踪和术中实时超声在肝癌个性化精准诊疗中应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 181-189.
[8] 戴宗伯, 张城硕, 郭庭维, 何知远, 赵昊宇, 张宇慈, 张佳林. 基于MRI影像组学机器学习构建肝细胞癌微血管侵犯预测模型[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(01): 36-44.
[9] 李鹏, 张维桢, 武国帅, 马伊凡, 张灵强. 超声造影在胰腺疾病中的应用研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(01): 119-123.
[10] 刘郁芳, 赵青. 直肠癌MRI影像学评估:从精准分期到预后预测的研究进展与展望[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(01): 31-36.
[11] 顾雨佳, 王晓军, 曹海波, 周林强, 石磊, 于涛, 任峰, 蒋才奇, 卞杰勇. 多模态辅助定位在合并颅骨缺损脑积水脑室-腹腔分流术中的临床应用[J/OL]. 中华神经创伤外科电子杂志, 2026, 12(01): 24-29.
[12] 高增霞, 贺云飞, 赵娜. DCE-MRI联合Gd-EOB-DTPA MRI纹理特征对肝细胞癌经导管动脉化疗栓塞术后疗效的评估[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 108-113.
[13] 常莉娜, 刘囡囡. DWI联合DCE-MRI定量参数对局部进展期直肠癌新辅助治疗后病理完全缓解的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 125-129.
[14] 杨斯博, 孙娅慧, 刘淑萍, 张海涛, 孙津津, 李利. 经J-VALVE TF系统治疗重度主动脉瓣反流围手术期超声评估一例[J/OL]. 中华诊断学电子杂志, 2026, 14(01): 44-48.
[15] 周健伟, 顾辰昊, 申雪纯, 杨菲, 何胜虎, 徐冰. 表现为重度二尖瓣反流的低流量低压差重度主动脉瓣狭窄一例[J/OL]. 中华诊断学电子杂志, 2026, 14(01): 49-52.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?