2019冠状病毒病中的骨骼肌损伤:行动呼吁
Skeletal Muscle Damage in COVID-19: A Call for Action.
作者信息
Ali Amira Mohammed, Kunugi Hiroshi
机构信息
Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt.
Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan.
出版信息
Medicina (Kaunas). 2021 Apr 12;57(4):372. doi: 10.3390/medicina57040372.
Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as well as the long-term consequences of muscle injury in disease survivors, are unclear. The current review briefly summarizes the literature for mechanisms, assessment measures, and interventions relevant to skeletal muscle insult in COVID-19 patients. Muscle injury is likely to be attributed to the cytokine storm, disease severity, malnutrition, prolonged physical inactivity during intensive care unit (ICU) stays, mechanical ventilation, and myotoxic drugs (e.g., dexamethasone). It has been assessed by imaging and non-imaging techniques (e.g., CT and electromyography), physical performance tests (e.g., six-minute walk test), anthropometric measures (e.g., calf circumference), and biomarkers of muscle dystrophy (e.g., creatine kinase). Interventions directed toward minimizing muscle loss among COVID-19 patients are lacking. However, limited evidence shows that respiratory rehabilitation improves respiratory function, muscle strength, quality of life, and anxiety symptoms in recovering older COVID-19 patients. Neuromuscular electrical stimulation may restore muscle condition in ICU-admitted patients, albeit empirical evidence is needed. Given the contribution of malnutrition to disease severity and muscle damage, providing proper nutritional management for emaciated patients may be one of the key issues to achieve a better prognosis and prevent the after-effects of the disease. Considerable attention to longer-term consequences of muscle injury in recovering COVID-19 patients is necessary.
实验室检查和身体成分量化测量方法(如计算机断层扫描,CT)均显示,2019冠状病毒病(COVID-19)有症状患者存在肌肉流失。肌肉流失与该疾病的不良预后相关。COVID-19患者肌肉损伤的确切机制以及疾病幸存者肌肉损伤的长期后果尚不清楚。本综述简要总结了与COVID-19患者骨骼肌损伤相关的机制、评估方法和干预措施的文献。肌肉损伤可能归因于细胞因子风暴、疾病严重程度、营养不良、在重症监护病房(ICU)住院期间长期身体活动不足、机械通气和肌毒性药物(如地塞米松)。它已通过成像和非成像技术(如CT和肌电图)、身体性能测试(如六分钟步行测试)、人体测量学方法(如小腿围)以及肌肉萎缩的生物标志物(如肌酸激酶)进行评估。目前缺乏针对尽量减少COVID-19患者肌肉流失的干预措施。然而,有限的证据表明,呼吸康复可改善康复期老年COVID-19患者的呼吸功能、肌肉力量、生活质量和焦虑症状。神经肌肉电刺激可能会恢复入住ICU患者的肌肉状况,尽管还需要经验证据。鉴于营养不良对疾病严重程度和肌肉损伤的影响,为消瘦患者提供适当的营养管理可能是实现更好预后和预防疾病后遗症的关键问题之一。有必要高度关注康复期COVID-19患者肌肉损伤的长期后果。