Gea Joaquim, Martínez-Llorens Juana, Ausín Pilar
Servicio de Neumología, Hospital del Mar-IMIM, Departamento de Ciencias Experimentales y de Salud, Universidad Pompeu Fabra, CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Barcelona, España.
Arch Bronconeumol. 2009;45 Suppl 4:36-41. doi: 10.1016/S0300-2896(09)72862-5.
Muscle function is frequently affected in patients with chronic obstructive pulmonary disease (COPD), influencing the symptoms and prognosis of this disease. The distribution and severity of this dysfunction are heterogeneous and therefore the main causes seem, in part, to be specific to the muscular group examined, which is the case of the overactivity and unfavorable geometry characteristic of respiratory muscles, compared with the relative inactivity of the muscles of the limbs. There are also factors that are common to all the muscles in the body. Notable among these factors are systemic inflammation, nutritional alterations, the use of certain drugs, hypoxia and the presence of comorbidity and/or advanced age. However, while the respiratory muscles show a phenotype adapted to their unfavorable situation and manage to partially compensate for this situation, the muscles of the limbs show involutive changes, which contribute to dysfunction. Therefore, although functional loss can develop in distinct muscular territories, the causes - and consequently the therapeutic approaches - differ, including nutritional support, muscle training and/or rest, depending on the muscle.
慢性阻塞性肺疾病(COPD)患者的肌肉功能常受影响,这会影响该疾病的症状和预后。这种功能障碍的分布和严重程度具有异质性,因此,部分主要原因似乎特定于所检查的肌肉群,呼吸肌的过度活动和不利的几何形状特征便是如此,与之相比,四肢肌肉相对不活动。也存在一些影响身体所有肌肉的共同因素。这些因素中值得注意的有全身炎症、营养改变、某些药物的使用、缺氧以及合并症的存在和/或高龄。然而,尽管呼吸肌表现出适应其不利状况的表型,并设法部分代偿这种状况,但四肢肌肉却出现退行性变化,这导致了功能障碍。因此,尽管不同肌肉区域会出现功能丧失,但其原因以及相应的治疗方法有所不同,包括营养支持、肌肉训练和/或休息,具体取决于所涉及的肌肉。