Kouidi E, Albani M, Natsis K, Megalopoulos A, Gigis P, Guiba-Tziampiri O, Tourkantonis A, Deligiannis A
Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Greece.
Nephrol Dial Transplant. 1998 Mar;13(3):685-99. doi: 10.1093/ndt/13.3.685.
Patients with end-stage renal disease on haemodialysis (HD) have limited work capacity. Many structural and functional alterations in skeletal muscles contribute to this disability.
To evaluate the effects of exercise training on uraemic myopathy, seven HD patients (mean age 44.1+/-17.2 years) were studied. Open muscle biopsies were taken from their vastus lateralis muscle before and after a 6-month exercise rehabilitation programme and examined by routine light- and transmission electron-microscopy. Histochemical stainings of frozen sections were performed and morphometric analysis was also applied to estimate the proportion of each fibre type and the muscle fibre area. Spiroergometric and neurophysiological testing and peak extension forces of the lower limbs were measured before and after exercise training.
All patients showed impaired exercise capacity, which was associated with marked muscular atrophy (mean area 2548+/-463 microm2) and reduction in muscle strength and nerve conduction velocity. All types of fibres were atrophied, but type II were more affected. The ultrastructural study showed severe degenerative changes in skeletal muscle fibres, mitochondria, and capillaries. Exercise training had an impressive effect on muscular atrophy; in particular the proportion of type II fibres increased by 51% and mean muscle fibre area by 29%. Favourable changes were also seen on the structure and number of capillaries and mitochondria. These results were confirmed by a 48% increase in VO2 peak and a 29% in exercise time, as well as an improvement in the peak muscle strength of the lower limbs and in nerve conduction velocity.
Skeletal muscle atrophy in HD patients contribute to their poor exercise tolerance. The application of an exercise training rehabilitation programme improved muscle atrophy markedly, and therefore had beneficial effects in overall work performance.
接受血液透析（HD）的终末期肾病患者工作能力有限。骨骼肌的许多结构和功能改变导致了这种残疾。
为评估运动训练对尿毒症性肌病的影响，对7例HD患者（平均年龄44.1±17.2岁）进行了研究。在为期6个月的运动康复计划前后，从他们的股外侧肌取开放肌肉活检标本，并用常规光学显微镜和透射电子显微镜进行检查。对冰冻切片进行组织化学染色，并进行形态计量分析以估计每种纤维类型的比例和肌纤维面积。在运动训练前后测量了心肺运动试验、神经生理学测试和下肢的峰值伸展力。
所有患者均表现出运动能力受损，这与明显的肌肉萎缩（平均面积2548±463平方微米）以及肌肉力量和神经传导速度降低有关。所有类型的纤维均萎缩，但II型纤维受影响更大。超微结构研究显示骨骼肌纤维、线粒体和毛细血管有严重的退行性改变。运动训练对肌肉萎缩有显著影响；特别是II型纤维的比例增加了51%，平均肌纤维面积增加了29%。在毛细血管和线粒体的结构和数量上也观察到了有利变化。这些结果通过峰值摄氧量增加48%、运动时间增加29%以及下肢峰值肌肉力量和神经传导速度的改善得到了证实。
HD患者的骨骼肌萎缩导致其运动耐力差。应用运动训练康复计划可显著改善肌肉萎缩，因此对整体工作表现有有益影响。
