目的 探讨基于肺康复的阻抗训练联合营养支持对老年慢性阻塞性肺疾病（COPD）衰弱患者肌少症及运动耐量的影响。方法 将2024年1月—2025年5月收治的80例老年COPD衰弱合并肌少症患者，分为对照组、观察组，各40例。所有患者均采取常规药物治疗，对照组予以营养支持，观察组在对照组基础上增加基于肺康复的阻抗训练。比较两组治疗前、治疗3个月后肌少症改善情况，运动耐量，肺功能指标，衰弱状态及生活质量。结果 治疗3个月后，观察组骨骼肌指数、握力、股四头肌肌厚度均较治疗前提高，且与对照组相比，观察组更高（P＜0.05）；治疗3个月后，两组6 min步行距离、日常活动代谢当量均较治疗前提高，Borg量表评分降低，且与对照组相比，观察组改善幅度更大（P＜0.05）；治疗3个月后，两组第一秒用力呼气容积（FEV1）、FEV1/用力肺活量（FVC）、最大通气量（MVV）均较治疗前改善，且与对照组相比，观察组更优（P＜0.05）；治疗3个月后，两组Fried衰弱表型评分、COPD评估测试（CAT）总分、圣乔治呼吸问卷（SGRQ）总分均较治疗前降低，且与对照组相比，观察组更低（P＜0.05）。结论 老年COPD衰弱合并肌少症患者采取基于肺康复的阻抗训练联合营养支持可改善其肌少症情况，提升运动耐量，并且提升患者肺功能水平，改善衰弱状态，提升生活质量。

       Objective To explore the effects of impedance training based on pulmonary rehabilitation combined with nutritional support on sarcopenia and exercise tolerance in elderly patients with chronic obstructive pulmonary disease（COPD）and frailty．Methods Eighty elderly patients with COPD and frailty complicated by sarcopenia，admitted from January 2024 to May 2025，were selected as the study subjects and divided into a control group and an observation group，with 40 patients in each group．All patients received conventional drug therapy．The control group received nutritional support，while the observation group received additional impedance training based on pulmonary rehabilitation on top of the matched group’s treatment．The improvement of sarcopenia，exercise tolerance，pulmonary function index，weakness status and quality of life before and 3 months after treatment were compared between the two groups．Results After 3 months of treatment，the skeletal muscle index，grip strength and quadriceps thickness of the observation group increased compared with that before treatment，and compared with the control group，the observation group was higher（P＜0.05）．After 3 months of treatment，the 6 min walking distance and daily activity metabolic equivalent of both groups increased compared with that before treatment，and the Borg Scale score decreased．Compared with the control group，the improvement of the observation group was better（P＜0.05）．After 3 months of treatment，Forced Expiratory Volume in one second（FEV1），FEV1/Forced Vital Capacity（FVC）and Maximal Voluntary Ventilation（MVV）of both groups improved compared with that before treatment，and the observation group  was better than that of the control group（P＜0.05）．After 3 months of treatment，the Fried weakness phenotype score，COPD Assessment Test（CAT）total score and St. George’s Respiratory Questionnaire（SGRQ）total score of both groups were lower than that before treatment，and the observation group  was lower than that of the control group（P＜0.05）．Conclusions Impedance training based on pulmonary rehabilitation combined with nutritional support can improve sarcopenia，enhance exercise tolerance，and improve pulmonary function levels，frailty status，and quality of life in elderly patients with COPD and frailty complicated by sarcopenia．

       目的 探讨肌少症性肥胖（SO）诊断标准的演进及其在中国老年人群中的本土化综合干预路径。方法 评述ESPEN/EASO最新共识，结合我国老年人代谢特征，系统分析“筛查-诊断-分期”流程及运动营养协同干预的临床效能。结果 SO诊断核心在于识别“隐性肥胖”，建议在AWGS2019标准基础上，叠加中国特异性腰围切点（男≥90 cm，女≥85 cm）或体脂率指标，并应用ALM/BMI校正肌肉质量。研究证实，以渐进式抗阻训练联合高蛋白营养（1.2~1.5 g·kg-1·d-1）为核心的协同模式，通过激活mTOR通路可显著逆转肌肉流失并改善胰岛素抵抗。融入八段锦等传统功法及乳清蛋白补充，能有效重塑中国患者“高碳水、低蛋白”的膳食习惯，提升依从性。结论 构建护士主导、社区依托的多学科管理模式，并借助远程健康工具实现闭环监测，是提升我国SO精准诊疗水平的关键路径。

      Objective To explore the evolution of diagnostic criteria for sarcopenic obesity（SO）and its localized comprehensive intervention pathways tailored to the metabolic characteristics of the Chinese elderly population．Methods The latest ESPEN/EASO consensus was reviewed．Combined with the metabolic profile of Chinese older adults，the “screening-diagnosis-staging” workflow and the clinical efficacy of synergistic exercise and nutrition interventions were systematically analyzed．Results The core of SO diagnosis lies in identifying “hidden obesity．”It is recommended to incorporate Chinese-specific waist circumference cut-offs（male≥90 cm，female≥85 cm）or body fat percentage into the AWGS2019 framework，utilizing ALM/BMI for muscle mass calibration．Evidence suggests that a synergistic model，centered on progressive resistance training（PRT）and high-protein nutrition（1.2~1.5 g·kg-1·d-1），can significantly reverse muscle loss and improve insulin resistance by activating the mTOR pathway．Integrating traditional Chinese exercises（e. g. ，Baduanjin）and whey protein supplementation effectively reshapes the “high-carbohydrate，low-protein” dietary habits of Chinese patients，thereby enhancing intervention adherence．Conclusions Establishing a nurse-led，community-based multidisciplinary management model，integrated with digital health tools for closed-loop monitoring，is a pivotal strategy for enhancing the precision of SO diagnosis and treatment in China．

目的 研究探讨体质指数和体脂百分比与老年类风湿关节炎患者发生肌少症的相关性。方法 纳入2018 年1月— 2020 年 6 月我院治疗的230例RA患者以及110例正常体检人员,分别设为研究组与对照组。采用双能X线骨密度仪测定骨骼肌肉量,四肢骨骼肌总量,体脂百分比(PBF),计算骨骼肌质量指数(SMI),体质指数(BMI);根据SMI水平将RA患者分为有、无肌少症组,比较两间组指标差异,采用Logistics回归分析探讨RA患者合并肌少症的独立影响因素。结果 ①RA组患者肌少症发生率高于对照组(49.1％ vs 18.2％,χ²=29.927,P＜0.001)。RA组患者消瘦百分比高于对照组(20.9％ vs 8％,χ²=5.375,P=0.020), RA组与正常对照组间BMI分组构成比比较差异有统计学意义(χ²=8.157,P=0.043)。②RA组BMI、骨骼肌量及四肢骨骼肌量均低于对照组,差异有统计学意义(P＜0.05),体脂百分比高于对照组,差异有统计学意义(P＜0.05)。③RA消瘦组肌少症发生率高于正常组(χ²=10.716,P＜0.001)、超重组(χ²=28.073,P＜0.001)和肥胖组(χ²=11.601,P＜0.001);RA消瘦组、正常组、超重组、肥胖组间肌少症发生率差异有统计学意义(χ²=32.522,P＜0.001)。PBF分组肌少症发生率正常组高于超重组,差异无统计学意义(χ²=2.609,P=0.016)。④RA肌少症组BMI消瘦百分比高于无肌少症组(22.1％ vs 3.4％,χ²=40.593,P＜0.001),BMI正常百分比高于无肌少症组(60.1％vs 51.3％,χ²=1.843,P=0.175);BMI超重百分比低于无肌少症组(15.0％ vs 39.3％,χ²=33.895,P＜0.001), BMI肥胖百分比低于无肌少症组(2.6％ vs 6.0％,χ²=1.531,P=0.216)。两组间PBF构成比比较差异无统计学意义(χ²=2.609,P=0.106)。⑤RA消瘦组患者肌少症的发生风险高于正常组(OR=7.197,95％CI:3.103～23.614,P＜0.001),超重RA患者肌少症的发生风险低于正常组(OR=0.095,95％CI:0.036～0.268,P=0.026),年龄为RA患者发生肌少症的危险因素(OR=1.096,95％CI:1.015～1.390,P＜0.001)。结论 肌少症在老年RA患者中发病率高,与体质指数具有一定相关性。