The Complexity of Treating Wasting in Ambulatory Rehabilitation: Is It Starvation, Sarcopenia, Cachexia or a Combination of These Conditions?

治理非臥床復康中消瘦病人的複雜性：是飢餓，老年肌肉衰減症，惡病質或以上綜合情況

Alison Yaxley ； Michelle D Miller ； Robert J Fraser ； Lynne Cobiac ； Maria Crotty

《Asia Pacific Journal of Clinical Nutrition》 21卷3期 (2012/09) Pp. 386-393

https://doi.org/10.6133/apjcn.2012.21.3.09

摘要

非卧床復康中病人的營養狀況多有受損。消瘦情況可分類為飢餓性、老年肌肉衰減症或惡病質。然而此等分類之區別不甚明確，錯誤診斷下可導致不恰當的調理。本文就187名年齡為60歲或以上的非卧床復康中病人的之數據作進一步分析，旨在識別其中患有一種或多種消瘦情況的病人，並探討其對於一般復康指標之影響。用於界定飢餓的標準為無脂肪體重指數及食慾評估量表（Council on Nutrition Appetite Questionnaire）的得分；老年肌肉衰減症以無脂肪體重指數及四頭肌力量來評定；惡病質則根據無脂肪體重指數及血清C-反應蛋白。本硏究根據幾項擬定的復康指標，就患有一種或多種消瘦狀況與沒有消瘦狀況的病人作出比較。被判斷為飢餓的消瘦病人（n=30），全數均患有老年肌肉衰減症，而其中有20名病人亦同時有惡病質的情況。被判斷為患老年肌肉衰減症的消瘦病人（n=75）當中，30名有飢餓的情況，37名有惡病質的情況。被判斷為惡病質的消瘦病人中（n=37），有20名有飢餓的情況，並全數患有老年肌肉衰減症。同時存在三種狀況的病人則有20名。與沒有消瘦徵狀的病人相比，飢餓病人的抑鬱程度較高（p=0.003），病者自我健康評估較差（p=0.032），身體機能亦較差（動作p=0.006；程序p=0.004）。患有老年肌肉衰減症的病人中，其身體機能亦較差（動作p=0.012；程序p=0.003）。患有惡病質的病人亦如是（動作p=0.025；程序p=0.042）。硏究結果示意，要於門診臨床環境下作出消瘦狀況的界定，會有困難。本次分析顯示，分類時會有所重叠，故百分之四十的消瘦病人（75/187）有可能被錯誤診斷，從而被處方不恰當的營養輔助。

關鍵字

消瘦 ； 飢餓 ； 老年肌肉衰減症 ； 惡病質 ； 年老者

並列摘要

Nutritional status is often impaired in ambulatory rehabilitation patients. Wasting conditions can be classified as starvation, sarcopenia or cachexia but differences between these are not well defined, and misdiagnosis may lead to inappropriate intervention. A secondary analysis of data from 187 ambulatory rehabilitation patients aged ≥60 years aimed to identify patients with one or more wasting condition, and investigate the impact on common rehabilitation outcomes. Starvation was defined by fat-free mass index and the Council on Nutrition Appetite Questionnaire score; sarcopenia by fat-free mass index and quadriceps strength; and cachexia by fat-free mass index and serum C-reactive protein. Selected rehabilitation outcomes were compared for those who were, and those who were not, identified as having one or more wasting condition. Of those identified with starvation (n=30), all were also identified as sarcopenic and 20 as cachectic; of those identified as sarcopenic (n=75), 30 had starvation and 37 were cachectic; and of those identified as cachectic (n=37), 20 had starvation and all were sarcopenic. Twenty participants were identified as having all three conditions. Those with starvation had higher level of depression (p=0.003), lower self-rated health (p=0.032), and lower levels of physical function (motor p=0.006; process p=0.004) than those with no evidence of a wasting condition. Those who had sarcopenia had lower physical function (motor p=0.012; process p=0.003) as did those with cachexia (motor p=0.025; process p=0.042). Results suggest problems in operationalising definitions in an ambulatory clinical setting. The overlap identified in this analysis suggests that up to 40% (75/187) of patients could be misidentified and prescribed inappropriate nutritional support.

並列關鍵字

wasting ； starvation ； sarcopenia ； cachexia ； aged