Albani Maria, Megalopoulos Angelos, Kiskinis Dimitris, Parashos Sotirios A, Grigoriadis Nikolaos, Guiba-Tziampiri Olympia
Department of Physiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54006, Greece.
BMC Musculoskelet Disord. 2002;3:8. doi: 10.1186/1471-2474-3-8. Epub 2002 Feb 25.
Morphological and electrophysiological studies of ischemic muscles in peripheral arterial disease disclosed evidence of denervation and fibre atrophy. The purpose of the present study is to describe morphological changes in ischemic muscles before and after reperfusion surgery in patients with peripheral occlusive arterial disease, and to provide an insight into the effect of reperfusion on the histochemistry of the reperfused muscle.
Muscle biopsies were obtained from the tibialis anterior of 9 patients with chronic peripheral arterial occlusive disease of the lower extremities, before and after aortofemoral bypass, in order to evaluate the extent and type of muscle fibre changes during ischemia and after revascularization. Fibre type content and muscle fibre areas were quantified using standard histological and histochemical methods and morphometric analysis. Each patient underwent concentric needle electromyography, nerve conduction velocity studies, and interstitial pressure measurements.
Preoperatively all patients showed muscle fibre atrophy of both types, type II fibre area being more affected. The mean fibre cross sectional area of type I was 3,745 microm2 and of type II 4,654 microm2. Fibre-type grouping, great variation in fibre size and angular fibres were indicative of chronic dennervation-reinnervation, in the absence of any clinical evidence of a neuropathic process. Seven days after the reperfusion the areas of both fibre types were even more reduced, being 3,086 microm2 for type I and 4,009 microm2 for type II, the proportion of type I fibres, and the interstitial pressure of tibialis anterior were increased.
The findings suggest that chronic ischemia of the leg muscles causes compensatory histochemical changes in muscle fibres resulting from muscle hypoxia, and chronic dennervation-reinnervation changes, resulting possibly from ischemic neuropathy. Reperfusion seems to bring the oxidative capacity of the previously ischemic muscle closer to normal.
对外周动脉疾病中缺血肌肉的形态学和电生理学研究揭示了去神经支配和纤维萎缩的证据。本研究的目的是描述外周闭塞性动脉疾病患者再灌注手术前后缺血肌肉的形态学变化，并深入了解再灌注对再灌注肌肉组织化学的影响。
从9例慢性下肢外周动脉闭塞性疾病患者的胫前肌获取肌肉活检标本，分别在主-股动脉旁路移植术前和术后，以评估缺血期间和血管重建后肌纤维变化的程度和类型。使用标准组织学和组织化学方法以及形态计量分析对纤维类型含量和肌纤维面积进行量化。每位患者均接受同心针肌电图检查、神经传导速度研究和组织间压力测量。
术前所有患者均显示两种类型的肌纤维萎缩，Ⅱ型纤维面积受影响更大。Ⅰ型纤维的平均横截面积为3745平方微米，Ⅱ型为4654平方微米。纤维类型分组、纤维大小的巨大差异和角形纤维表明存在慢性去神经-再支配，而无任何神经病变过程的临床证据。再灌注7天后，两种纤维类型的面积进一步减小，Ⅰ型为3086平方微米，Ⅱ型为4009平方微米，Ⅰ型纤维比例和胫前肌组织间压力增加。
研究结果表明，腿部肌肉的慢性缺血会导致肌肉缺氧引起的肌纤维代偿性组织化学变化，以及可能由缺血性神经病变导致的慢性去神经-再支配变化。再灌注似乎使先前缺血肌肉的氧化能力更接近正常。
