長新冠病患合併肌少症之診治

Diagnosis and Management of Long COVID-19 Patients with Sarcopenia

新冠肺炎的急性嚴重肺炎和全身炎症持續約2週，引發全身性發炎細胞激素風暴，進而損害多重器官和系統。罹患急性COVID-19患者可能出現各式各樣臨床表徵，從無症狀到嚴重急性呼吸衰竭和高死亡率。嚴重COVID-19患者可能需要加護重症治療，甚至呼吸器治療嚴重肺炎症狀，也可能出現急性肌少症（acute sarcopenia），早期體重約減輕5-10%，並影響臨床後果。此外，長期發炎參與複雜免疫反應，可能加劇長新冠患者的分解代謝和肌肉流失長達數月至數年。長新冠（long COVID-19）是一種新的症候群，在初期罹患新冠肺炎後數月內發生，患者可能出現疲勞、呼吸困難、關節痛等症狀，且生理功能和生活品質明顯變差。在本文中，我們將討論長新冠患者急性肌少症的流行病學、症狀、病理生理機制和臨床處置。我們應提高警覺，及早發現患有肌少症的長新冠患者。必須從多層面著手，才能有效管控臨床情況，包括營養攝取充足、妥善物理治療和心肺復健、心理治療等，才能有效改善臨床成果。

The acute phase of severe coronavirus disease 2019 (COVID-19) including pneumonia and systemic inflammation lasts approximately 2 weeks. The development of systemic inflammatory cytokine storms damages multi-organ and organ systems. Patients with acute COVID-19 infection may present a wide spectrum of clinical symptoms, from asymptomatic to severe acute respiratory failure and high mortality. In addition to severe dyspnea that may need intensive care or even respirator treatment for pneumonia symptoms, severe COVID-19 patients may also develop acute sarcopenia manifested by about 5-10% body weight loss and affect the clinical outcomes. Furthermore, long-lasting inflammatory involvement and complex immunological events may exacerbate catabolism and muscle loss in those patients with long COVID-19 for months to years. Long coronavirus disease 19 (COVID-19) is a syndrome occurring within a few months after initial COVID-19. Long COVID-19 patients may present fatigue, dyspnea, joint pain, etc., as well as significantly worse physiological function and quality of life. In this article, we discuss the epidemiology, symptoms, pathophysiologic mechanisms, and clinical management of acute sarcopenia in long COVID-19 patients. We need to raise the awareness and early detection of long COVID-19 patients with sarcopenia. To improve the clinical outcomes, a multidisciplinary approach is essential to efficiently manage the clinical scenario, including adequate nutritional support, optimal physical therapy, cardio-pulmonary rehabilitation, and psychological intervention as well.