Fregonezi Guilherme, Azevedo Ingrid G, Resqueti Vanessa R, De Andrade Armèle D, Gualdi Lucien P, Aliverti Andrea, Dourado-Junior Mário Et, Parreira Verônica F
Physical Therapy Department of Universidade Federal do Rio Grande do Norte, Natal, Brazil
Physical Therapy Department of Universidade Federal do Rio Grande do Norte, Natal, Brazil.
Respir Care. 2015 Apr;60(4):533-9. doi: 10.4187/respcare.03367. Epub 2015 Jan 13.
Neuromuscular diseases (NMDs) lead to different weakness patterns, and most patients with NMDs develop respiratory failure. Inspiratory and expiratory muscle strength can be measured by maximum static inspiratory pressure (PImax) and maximum static expiratory pressure (PEmax), and the relationship between them has not been well described in healthy subjects and subjects with NMDs. Our aim was to assess expiratory/inspiratory muscle strength in NMDs and healthy subjects and calculate PEmax/PImax ratio for these groups.
Seventy (35 males) subjects with NMDs (amyotrophic lateral sclerosis, myasthenia gravis, and myotonic dystrophy), and 93 (47 males) healthy individuals 20-80 y of age were evaluated for anthropometry, pulmonary function, PImax, and PEmax, respectively.
Healthy individuals showed greater values for PImax and PEmax when compared with subjects with NMDs. PEmax/PImax ratio for healthy subjects was 1.31 ± 0.26, and PEmax%/PImax% was 1.04 ± 0.05; for subjects with NMDs, PEmax/PImax ratio was 1.45 ± 0.65, and PEmax%/PImax% ratio was 1.42 ± 0.67. We found that PEmax%/PImax% for myotonic dystrophy was 0.93 ± 0.24, for myasthenia gravis 1.94 ± 0.6, and for amyotrophic lateral sclerosis 1.33 ± 0.62 when we analyzed them separately. All healthy individuals showed higher PEmax compared with PImax. For subjects with NMDs, the impairment of PEmax and PImax is different among the 3 pathologies studied (P < .001).
Healthy individuals and subjects with NMDs showed higher PEmax in comparison to PImax regarding the PEmax/PImax ratio. Based on the ratio, it is possible to state that NMDs show different patterns of respiratory muscle strength loss. PEmax/PImax ratio is a useful parameter to assess the impairment of respiratory muscles in a patient and to customize rehabilitation and treatment.
神经肌肉疾病（NMDs）会导致不同的肌无力模式，大多数NMDs患者会出现呼吸衰竭。吸气和呼气肌力量可通过最大静态吸气压力（PImax）和最大静态呼气压力（PEmax）来测量，而在健康受试者和NMDs受试者中，它们之间的关系尚未得到充分描述。我们的目的是评估NMDs患者和健康受试者的呼气/吸气肌力量，并计算这些组的PEmax/PImax比值。
分别对70名（35名男性）患有NMDs（肌萎缩侧索硬化症、重症肌无力和强直性肌营养不良症）的受试者以及93名（47名男性）年龄在20至80岁之间的健康个体进行人体测量、肺功能、PImax和PEmax评估。
与NMDs受试者相比，健康个体的PImax和PEmax值更高。健康受试者的PEmax/PImax比值为1.31±0.26，PEmax%/PImax%为1.04±0.05；对于NMDs受试者，PEmax/PImax比值为1.45±0.65，PEmax%/PImax%比值为1.42±0.67。当我们分别分析时，发现强直性肌营养不良症的PEmax%/PImax%为0.93±0.24，重症肌无力为1.94±0.6，肌萎缩侧索硬化症为1.33±0.62。所有健康个体的PEmax均高于PImax。对于NMDs受试者，在所研究的3种病理情况中，PEmax和PImax的损害情况不同（P<.001）。
就PEmax/PImax比值而言，健康个体和NMDs受试者的PEmax均高于PImax。基于该比值，可以说NMDs表现出不同的呼吸肌力量丧失模式。PEmax/PImax比值是评估患者呼吸肌损害以及定制康复和治疗方案的有用参数。
