1 Division of Pulmonary and Critical Care Medicine and.
2 Department of Molecular and Cellular Physiology, Albany Medical College, Albany, New York.
Am J Respir Crit Care Med. 2018 Jul 15;198(2):175-186. doi: 10.1164/rccm.201710-2140CI.
Skeletal muscle dysfunction occurs in patients with chronic obstructive pulmonary disease (COPD) and affects both ventilatory and nonventilatory muscle groups. It represents a very important comorbidity that is associated with poor quality of life and reduced survival. It results from a complex combination of functional, metabolic, and anatomical alterations leading to suboptimal muscle work. Muscle atrophy, altered fiber type and metabolism, and chest wall remodeling, in the case of the respiratory muscles, are relevant etiological contributors to this process. Muscle dysfunction worsens during COPD exacerbations, rendering patients progressively less able to perform activities of daily living, and it is also associated with poor outcomes. Muscle recovery measures consisting of a combination of pulmonary rehabilitation, optimized nutrition, and other strategies are associated with better prognosis when administered in stable patients as well as after exacerbations. A deeper understanding of this process' pathophysiology and clinical relevance will facilitate the use of measures to alleviate its effects and potentially improve patients' outcomes. In this review, a general overview of skeletal muscle dysfunction in COPD is offered to highlight its relevance and magnitude to expert practitioners and scientists as well as to the average clinician dealing with patients with chronic respiratory diseases.
慢性阻塞性肺疾病(COPD)患者存在骨骼肌功能障碍,影响通气和非通气肌群。它是一种非常重要的合并症,与生活质量差和生存率降低有关。它是由导致肌肉工作效果不佳的多种功能、代谢和解剖改变共同作用引起的。在呼吸肌中,肌肉萎缩、纤维类型和代谢改变以及胸壁重塑是导致这种情况的重要病因。COPD 加重期间肌肉功能障碍会恶化,使患者逐渐无法进行日常活动,并且与不良预后相关。在稳定期和加重后,由肺康复、优化营养和其他策略组成的肌肉恢复措施与更好的预后相关。更深入地了解这一过程的病理生理学和临床相关性将有助于采取措施减轻其影响并可能改善患者的预后。在这篇综述中,我们对 COPD 中的骨骼肌功能障碍进行了概述,以强调其对专家和科学家以及处理慢性呼吸系统疾病患者的普通临床医生的相关性和重要性。
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