Reason S L, Voermans N, Lucia A, Vissing J, Quinlivan R, Bhai S, Wakelin A
International Association for Muscle Glycogen Storage Disease, CA, USA.
Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Neuromuscul Disord. 2023 Jul;33(7):575-579. doi: 10.1016/j.nmd.2023.05.006. Epub 2023 Jun 12.
McArdle disease (glycogen storage disease type V; GSDV) is a rare genetic disease caused by the inability to break down glycogen in skeletal muscle due to a deficiency in myophosphorylase. Glycolysis is only partially blocked in GSDV, as muscle fibres can take up circulating glucose and convert it to glucose-6-phosphate downstream of the metabolic block. Because skeletal muscle predominantly relies on anaerobic energy during the first few minutes of transition from rest to activity, and throughout more intense activities, individuals with GSDV experience muscle fatigue/pain, tachypnea, and tachycardia during these activities. If warning signs are not heeded, a muscle contracture may rapidly occur, and if significant, may lead to acute rhabdomyolysis. Without a cure or treatment, individuals with GSDV must be consistent in employing proper management techniques; however, this can be challenging due to the nuances inherent in this metabolic myopathy. The International Association for Muscle Glycogen Storage Disease collaborated with an international team of five expert clinicians to identify areas of learning to achieve an optimal state. A Continuum of Care model was developed that outlines five pivotal steps (diagnosis; understanding; acceptance; learning and exercise) to streamline assessments and more succinctly assist clinicians in determining patient-specific learning needs. This model serves as a translational tool to help optimize care for this patient population.
麦克尔迪氏病(糖原贮积病Ⅴ型;GSDV)是一种罕见的遗传性疾病,由于肌磷酸化酶缺乏,导致骨骼肌中的糖原无法分解。在GSDV中,糖酵解仅部分受阻,因为肌纤维可以摄取循环中的葡萄糖,并在代谢阻断的下游将其转化为6-磷酸葡萄糖。由于骨骼肌在从休息过渡到活动的最初几分钟以及整个更剧烈的活动过程中主要依赖无氧能量,GSDV患者在这些活动中会出现肌肉疲劳/疼痛、呼吸急促和心动过速。如果不注意警示信号,可能会迅速发生肌肉挛缩,如果情况严重,可能会导致急性横纹肌溶解。由于这种代谢性肌病存在细微差别,在没有治愈方法或治疗手段的情况下,GSDV患者必须始终如一地采用适当的管理技术;然而,这可能具有挑战性。国际肌肉糖原贮积病协会与由五位专家临床医生组成的国际团队合作,确定了实现最佳状态的学习领域。开发了一种连续护理模式,概述了五个关键步骤(诊断;理解;接受;学习和锻炼),以简化评估,并更简洁地帮助临床医生确定患者特定的学习需求。该模式作为一种转化工具,有助于优化对这一患者群体的护理。