サルコペニアの総説論文

今日はサルコペニアの最近の総説論文を2つ紹介します。

①Waters DL, Baumgartner RN, Garry PJ, Vellas B. Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. Clin Interv Aging. 2010 Sep 7;5:259-70.

下記のHPで全文のPDFを見ることができます。

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938033/pdf/cia-5-259.pdf

有効な治療方法として、レジスタンストレーニング単独、レジスタンストレーニングと栄養療法の併用、ACE阻害剤の使用が紹介されています。ACE阻害剤を使用したADLに何らかの障害がある高齢者を対象としたRCTで、運動能力の改善と転倒が少ないという結果が出ています（Sumukadas D, Witham MD, Struthers AD, McMurdo ME. Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial. CMAJ. 2007;177(8):867–874.)。

ACE阻害剤の骨格筋に対する作用は不明ですが、高血圧を認めるサルコペニアの方にはACE阻害剤を処方してもよいと思います。誤嚥性肺炎の予防目的で高血圧を認める嚥下障害患者に処方するのと同じですね。

Abstract
Sarcopenia is the loss of skeletal muscle mass and function with aging. Although the term sarcopenia was first coined in 1989, its etiology is still poorly understood. Moreover, a consensus for defining sarcopenia continues to elude us. Sarcopenic changes in the muscle include losses in muscle fiber quantity and quality, alpha-motor neurons, protein synthesis rates, and anabolic and sex hormone production. Other factors include basal metabolic rate, increased protein dietary requirements, and chronic inflammation secondary to age-related changes in cytokines and oxidative stress. These changes lead to decreased overall physical functioning, increased frailty, falls risk, and ultimately the loss of independent living. Because the intertwining relationships of these factors are complex, effective treatment options are still under investigation. The published data on sarcopenia are vast, and this review is not intended to be exhaustive. The aim of this review is to provide an update on the current knowledge of the definition, etiology, consequences, and current clinical trials that may help address this pressing public health problem for our aging populations.

②Burton LA, Sumukadas D. Optimal management of sarcopenia. Clin Interv Aging. 2010 Sep 7;5:217-28.

下記のHPで全文のPDFを見ることができます。

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938029/pdf/cia-5-217.pdf

サルコペニアの要因の1つにレニンーアンギオテンシン系の変化が挙げられています。このことがACE阻害剤の有効性につながるのかもしれません。ただ、サルコペニアへの薬物療法のエビデンスはACE阻害剤に限られていて、やはりレジスタンストレーニングが最も効果的です。問題は実際にどのようにサルコペニアの方にレジスタンストレーニングを適切に指導し実施してもらうかです。診断方法も課題が多いですが。

Abstract
Sarcopenia is the progressive generalized loss of skeletal muscle mass, strength, and function which occurs as a consequence of aging. With a growing older population, there has been great interest in developing approaches to counteract the effects of sarcopenia, and thereby reduce the age-related decline and disability. This paper reviews (1) the mechanisms of sarcopenia, (2) the diagnosis of sarcopenia, and (3) the potential interventions for sarcopenia. Multiple factors appear to be involved in the development of sarcopenia including the loss of muscle mass and muscle fibers, increased inflammation, altered hormonal levels, poor nutritional status, and altered renin-angiotensin system. The lack of diagnostic criteria to identify patients with sarcopenia hinders potential management options. To date, pharmacological interventions have shown limited efficacy in counteracting the effects of sarcopenia. Recent evidence has shown benefits with angiotensin-converting enzyme inhibitors; however, further randomized controlled trials are required. Resistance training remains the most effective intervention for sarcopenia; however, older people maybe unable or unwilling to embark on strenuous exercise training programs.