Kim Sang Hun, Shin Myung Jun, Shin Yong Beom, Kim Ki Uk
Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
J Bone Metab. 2019 May;26(2):65-74. doi: 10.11005/jbm.2019.26.2.65. Epub 2019 May 31.
Sarcopenia is frequently associated with chronic diseases such as chronic obstructive pulmonary disease (COPD) and cancer. COPD, which is characterized by an irreversible airflow limitation, exacerbates respiratory distress as the disease progresses. The prevalence of sarcopenia in stable COPD was reported to be 15% to 25% in previous foreign studies and 25% in a Korean study. As the amount of activity decreases, muscle mass decreases and eventually oxygen cannot be used effectively, resulting in a vicious cycle of deterioration of exercise capacity. Deconditioning due to decreased activity is a major cause of limb muscle dysfunction in patients with COPD. In these patients, the factors that decrease muscle strength and endurance include chronic inflammation, oxidative stress, inactivity, hypoxemia, hormone abnormality, deficits of nutrients such as protein and vitamin D, and the use of systemic corticosteroid. Therefore, treatment and management should either inhibit this process or should be directed toward supplementing the deficiency, such as with exercise, nutritional support, and medications and supplements. The relationship between sarcopenia and COPD is increasingly being reported, with some overlap in clinical features and treatments. We are fascinated to be able to diagnose 2 diseases through similar physical performance tests and to improve both diseases using the same treatment such as exercise. Therefore, this review summarizes the clinical relevance and integrative management of the 2 diseases.
肌肉减少症常与慢性疾病相关,如慢性阻塞性肺疾病(COPD)和癌症。COPD以不可逆的气流受限为特征,随着疾病进展会加剧呼吸窘迫。国外既往研究报道,稳定期COPD患者中肌肉减少症的患病率为15%至25%,一项韩国研究中的患病率为25%。随着活动量减少,肌肉量减少,最终氧气无法有效利用,导致运动能力恶化的恶性循环。活动减少导致的身体机能下降是COPD患者肢体肌肉功能障碍的主要原因。在这些患者中,导致肌肉力量和耐力下降的因素包括慢性炎症、氧化应激、缺乏运动、低氧血症、激素异常、蛋白质和维生素D等营养素缺乏以及全身使用糖皮质激素。因此,治疗和管理应抑制这一过程,或针对补充缺乏的物质,如进行运动、营养支持以及使用药物和补充剂。肌肉减少症与COPD之间的关系报道越来越多,二者在临床特征和治疗方面存在一些重叠。我们很高兴能够通过相似的身体性能测试诊断这两种疾病,并使用相同的治疗方法(如运动)改善这两种疾病。因此,本综述总结了这两种疾病的临床相关性及综合管理。