肌肉减少症与卒中患者整体、运动、认知及吞咽功能预后的关联：一项系统综述与荟萃分析

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中文摘要

目的： 肌肉减少症已被证明与卒中的预后相关。本研究旨在系统评价肌肉减少症对卒中患者整体、运动、认知及吞咽功能结局的影响。
方法： 从PubMed、Embase、Web of Science、Cochrane Library和Scopus数据库中检索调查肌肉减少症与卒中多维预后结局之间关联的相关研究。主要结局是采用改良Rankin量表（mRS）评估的整体功能预后不良风险。次要结局包括运动功能评分（功能独立性评定-运动部分，FIM-运动）、认知功能评分以及吞咽功能障碍风险。
结果： 最终纳入36项队列研究。汇总结果表明，合并肌肉减少症的卒中患者整体功能预后不良风险显著升高（mRS，OR = 2.43，95% CI：1.95至3.03，p < 0.001）。肌肉减少症组的运动功能评分（FIM-运动，SMD = -0.94，95% CI：-1.11至-0.77，p < 0.001）和认知功能评分（FIM-认知或蒙特利尔认知评估，SMD = -0.95，95% CI：-1.22至-0.69，p < 0.001）显著低于非肌肉减少症组，而吞咽功能障碍风险显示出显著但非显著的升高（气管插管或功能性经口摄食量表，OR = 1.45，95% CI：0.94至2.25，p = 0.09）。亚组分析表明，患者人群、mRS截断值、随访时间、卒中类型和肌肉减少症诊断标准是异质性的主要来源。敏感性分析证实了结果的稳健性。Egger检验提示存在发表偏倚，但采用剪补法校正后结论仍然有效。
结论： 肌肉减少症是卒中患者整体、运动、认知及吞咽功能预后不良的重要危险因素。在临床实践中，应将肌肉减少症筛查纳入卒中患者的常规评估，并对高危人群及时实施个体化干预以改善长期预后。

英文摘要

OBJECTIVE: Sarcopenia has been demonstrated to correlate with the prognosis of stroke. This study aimed to systematically evaluate the impact of sarcopenia on global, motor, cognitive, and swallowing function outcomes in stroke patients.
METHODS: Relevant studies investigating the association between sarcopenia and multidimensional prognostic outcomes in stroke were retrieved from the PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases. The primary outcome was the risk of poor global functional prognosis assessed by the modified Rankin Scale (mRS). Secondary outcomes included motor function scores (Functional Independence Measure-motor, FIM-motor), cognitive function scores, and the risk of swallowing dysfunction.
RESULTS: A total of 36 cohort studies were finally included. Pooled results indicated that stroke patients with comorbid sarcopenia faced a notably elevated risk of poor global functional prognosis (mRS, OR = 2.43, 95% CI: 1.95 to 3.03, p < 0.001). The motor function scores (FIM-motor, SMD = -0.94, 95% CI: -1.11 to -0.77, p < 0.001) and cognitive function scores (FIM-cognition or Montreal Cognitive Assessment, SMD = -0.95, 95% CI: -1.22 to -0.69, p < 0.001) in the sarcopenia group were significantly lower than those in the non-sarcopenia group, while the risk of swallowing dysfunction showed a notable but non-significant elevation (endotracheal intubation or Functional Oral Intake Scale, OR = 1.45, 95% CI: 0.94 to 2.25, p = 0.09). Subgroup analyses indicated that the patient populations, cut-off value of mRS, follow-up duration, stroke type, and diagnostic criteria for sarcopenia were the main sources of heterogeneity. Sensitivity analyses confirmed the robustness of the results. Egger's test suggested the presence of publication bias, but the conclusions remained valid after correction using the trim-and-fill method.
CONCLUSION: Sarcopenia is an important risk factor for poor global, motor, cognitive, and swallowing function prognosis in stroke patients. In clinical practice, sarcopenia screening should be incorporated into the routine assessment of stroke patients, and individualized interventions should be promptly implemented for high-risk populations to improve long-term prognosis.