Matsuura Eiji, Nozuma Satoshi, Dozono Mika, Kodama Daisuke, Tanaka Masakazu, Kubota Ryuji, Takashima Hiroshi
Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan.
Division of Neuroimmunology, Joint Research Center for Human Retrovirus Infection, Kagoshima University, Kagoshima 890-8520, Japan.
Pathogens. 2023 Apr 13;12(4):592. doi: 10.3390/pathogens12040592.
Human T-cell leukemia virus-1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive neurological disease that arises from HTLV-1 infection. Pathologically, the condition is characterized by diffuse myelitis, which is most evident in the thoracic spinal cord. Clinical manifestations of the infectious disease, HAM/TSP, are empirically known to include weakness of the proximal muscles of the lower extremities and atrophy of the paraspinal muscles, which is characteristic of the distribution of disturbed muscles usually seen in muscular diseases, except that the upper extremities are almost normal. This unique clinical presentation is useful information for physicians and physical therapists involved in diagnosing and rehabilitating patients with HAM/TSP, as well as critical information for understanding the pathogenesis of HAM/TSP. However, the precise pattern of muscle involvement in this condition has yet to be reported. The purpose of this study was to identify the muscles affected by HAM/TSP in order to understand the pathogenesis of HAM/TSP as well as to aid in the diagnosis and rehabilitation of HAM/TSP. A retrospective review of medical records was conducted on 101 consecutively admitted patients with HAM/TSP at Kagoshima University Hospital. Among 101 patients with HAM/TSP, all but three had muscle weakness in the lower extremities. Specifically, the hamstrings and iliopsoas muscle were the most frequently affected in over 90% of the patients. Manual muscle testing (MMT) revealed that the iliopsoas was the weakest of the muscles assessed, a consistent feature from the early to advanced stages of the disease. Our findings demonstrate a unique distribution of muscle weakness in HAM/TSP, with the proximal muscles of the lower extremities, particularly the iliopsoas muscle, being the most frequently and severely affected.
人类嗜T淋巴细胞病毒1型（HTLV-1）相关脊髓病/热带痉挛性截瘫（HAM/TSP）是一种由HTLV-1感染引起的缓慢进展性神经疾病。病理上，该病的特征为弥漫性脊髓炎，在胸段脊髓最为明显。经验表明，传染病HAM/TSP的临床表现包括下肢近端肌肉无力和椎旁肌萎缩，这是肌肉疾病中常见的受累肌肉分布特征，但上肢几乎正常。这种独特的临床表现对参与HAM/TSP患者诊断和康复的医生及物理治疗师来说是有用信息，也是理解HAM/TSP发病机制的关键信息。然而，这种疾病中肌肉受累的确切模式尚未见报道。本研究的目的是确定受HAM/TSP影响的肌肉，以了解HAM/TSP的发病机制，并辅助HAM/TSP的诊断和康复。对鹿儿岛大学医院连续收治的101例HAM/TSP患者的病历进行了回顾性分析。在101例HAM/TSP患者中，除3例患者外，其余均有下肢肌肉无力。具体而言，超过90%的患者中，腘绳肌和髂腰肌受累最为频繁。徒手肌力测试（MMT）显示，髂腰肌是评估的肌肉中最弱的，这是疾病从早期到晚期的一个持续特征。我们的研究结果表明，HAM/TSP患者存在独特的肌肉无力分布，下肢近端肌肉，尤其是髂腰肌，受累最为频繁和严重。
