Department of Renal Medicine and Transplantation, The Royal London Hospital, London E1 1BB, UK Queens Hospital, Romford RM7 0AG, UK.
Nephrol Dial Transplant. 2014 Sep;29(9):1655-65. doi: 10.1093/ndt/gft070. Epub 2013 Apr 25.
The term uraemic myopathy has been used loosely to describe the skeletal muscle abnormalities in uraemic patients. However, it does not fully explain the observed abnormalities as recent research has documented a normal skeletal muscle physiology in the presence of reduced muscle force, selective structural changes and significant muscle wasting. Ageing is associated with sarcopenia (muscle wasting) and an increase in the prevalence of chronic kidney disease (CKD), which accelerates the normal physiological muscle wasting. Similar to sarcopenia, muscle wasting in uraemic patients appears to be the hallmark of the disease and its aetiology is multifactorial with hormonal, immunologic and myocellular changes, metabolic acidosis, reduced protein intake and physical inactivity. Uraemic sarcopenia presents a high probability for morbidity and mortality and consequently a high priority for muscle wasting prevention and treatment in these patients. Perhaps, the use of the term 'uraemic sarcopenia' would provide recognition by the renal community for this devastating problem. The purpose of this review is to relate the findings of the recent publications that describe abnormalities in uraemic skeletal muscle to the possible pathogenesis of muscle wasting and its consequences in patients with CKD.
“尿毒症性肌病”这一术语被广泛用于描述尿毒症患者的骨骼肌异常。然而，由于最近的研究表明，在肌肉力量降低的情况下，骨骼肌的生理学是正常的，同时还存在选择性的结构变化和显著的肌肉消耗，因此该术语并不能完全解释所观察到的异常。随着年龄的增长，会出现肌肉减少症（肌肉消耗）和慢性肾脏病（CKD）患病率的增加，这会加速正常的生理性肌肉消耗。与肌肉减少症类似，尿毒症患者的肌肉消耗似乎是该疾病的标志，其病因是多因素的，包括激素、免疫和肌细胞变化、代谢性酸中毒、蛋白质摄入减少和身体活动减少。尿毒症性肌肉减少症使患者有很高的发病率和死亡率，因此，预防和治疗肌肉消耗对这些患者来说是重中之重。也许，使用“尿毒症性肌肉减少症”这一术语将引起肾脏界对这一严重问题的重视。本文综述的目的是将最近描述尿毒症骨骼肌异常的研究结果与肌肉消耗的可能发病机制及其在 CKD 患者中的后果联系起来。
