Barreiro Esther, Jaitovich Ariel
Respiratory Medicine Department-Muscle Wasting and Cachexia in Chronic Respiratory Diseases and Lung Cancer Research Group, Institute of Medical Research of Hospital del Mar (IMIM)-Hospital del Mar, Parc de Salut Mar, Barcelona Biomedical Research Park (PRBB), Barcelona, Spain.
Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
J Thorac Dis. 2018 May;10(Suppl 12):S1415-S1424. doi: 10.21037/jtd.2018.04.168.
Patients with chronic obstructive pulmonary disease (COPD) experience several systemic manifestations such skeletal muscle dysfunction with and without muscle mass loss. Moreover, frequent comorbidities such as nutritional abnormalities, heart failure, and pulmonary hypertension, which are frequently associated with COPD may further contribute to skeletal muscle mass loss and dysfunction. Muscle dysfunction impairs the patients' exercise capacity and quality of life as daily life activities may be hampered by this problem. Importantly, impaired muscle function and mass loss have been shown to impact negatively on the patients' prognosis and survival in several studies. Thus, this is a major clinical problem that deserves special attention in clinical settings. During the course of exacerbations muscle mass loss takes place, hence aggravating muscle status and performance even after hospital discharge, especially in the frequently exacerbator patients. Several factors and biological mechanisms are involved in the etiology of COPD muscle dysfunction. The biological mechanisms identified so far offer a niche for therapeutic interventions in the patients. In the current review, a general overview of the most relevant etiologic factors and their target biological mechanisms through which muscle mass loss and dysfunction take place in both the respiratory and lower limb muscles in COPD patients is provided. We conclude that more clinical research is still needed targeted to test several therapeutic interventions. Given its prognostic value, the assessment of skeletal muscle dysfunction should be included in the routine evaluation of patients with chronic respiratory disorders and in critical care settings.
慢性阻塞性肺疾病（COPD）患者会出现多种全身表现，如伴有或不伴有肌肉量减少的骨骼肌功能障碍。此外，COPD常伴有的营养异常、心力衰竭和肺动脉高压等合并症，可能会进一步导致骨骼肌量减少和功能障碍。肌肉功能障碍会损害患者的运动能力和生活质量，因为日常生活活动可能会受到这个问题的阻碍。重要的是，多项研究表明，肌肉功能受损和肌肉量减少会对患者的预后和生存产生负面影响。因此，这是一个主要的临床问题，在临床环境中值得特别关注。在病情加重期间，肌肉量会减少，从而即使在出院后也会加重肌肉状态和表现，尤其是在频繁加重的患者中。COPD肌肉功能障碍的病因涉及多种因素和生物学机制。目前已确定的生物学机制为对患者进行治疗干预提供了空间。在本综述中，我们对COPD患者呼吸肌和下肢肌肉中肌肉量减少和功能障碍发生的最相关病因及其靶向生物学机制进行了概述。我们得出结论，仍需要更多的临床研究来测试多种治疗干预措施。鉴于其预后价值，骨骼肌功能障碍的评估应纳入慢性呼吸系统疾病患者的常规评估以及重症监护环境中。
