Linking work factors to neck myalgia: the nitric oxide/oxygen ratio hypothesis
Linking work factors to neck myalgia: the nitric oxide/oxygen ratio hypothesis
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DOI：
10.1016/j.mehy.2003.12.015
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发表时间：
2004-01-01
影响因子：
4.7
通讯作者：
Eriksen, W
中科院分区：
文献类型：
--
作者：
Eriksen, W
与工作有关的暴露和颈部肌痛之间的病理生理联系仍然是一个谜。根据这里提出的假设，颈部肌痛是诱发时，由于心理压力或长期低头颈部屈曲在工作中的交感神经血管收缩相结合的低水平收缩的肌肉。这些缺血性收缩增加了肌纤维中的一氧化氮/氧浓度比，从而增强了一氧化氮对线粒体细胞色素氧化酶的可逆抑制。其结果是三磷酸腺苷的消耗，其促进乳酸的产生/流出，进而激活和敏化结缔组织中的质子敏感性伤害性纤维，引起肌痛和压痛。高雌激素水平，使肌肉中一氧化氮合酶的高表达，加重了这种情况。在一氧化氮持续抑制细胞色素氧化酶的过程中，可能会产生过氧亚硝酸盐，并导致线粒体电子载体链中几种酶的不可逆失活。随着反复发作，越来越多的细胞呼吸酶能力被灭活。即使这个过程只发生在一小部分肌肉纤维中，它也可能导致疼痛的频繁加剧。过氧亚硝酸盐的影响也可以解释在许多颈部肌痛患者的肌内肌中发现的线粒体异常。肾上腺素能拮抗剂和一氧化氮合酶抑制剂可减轻症状。抗坏血酸、α-生育酚和黄酮类化合物是安全有效的过氧亚硝基阴离子清除剂，可预防慢性病。最有效的非药物措施可能是减少工作中长时间的头向下颈部屈曲和心理社会压力。(C)2004爱思唯尔有限公司保留所有权利。
The pathophysiological link between work-related exposures and neck myalgia remains a puzzle. According to the hypothesis presented here, neck myalgia is evoked when low-level contractions in the trapezius muscle are combined with sympathetic vasoconstriction due to psychological stress or prolonged head-down neck flexion at work. These ischemic contractions increase nitric oxide/oxygen concentration ratio in the muscle fibres, enhancing herewith the reversible inhibition of mitochondrial cytochrome oxidase by nitric oxide. The result is depletion of adenosine triphosphate, which elicits production/efflux of lactic acid, in turn activating and sensitising proton-sensitive nociceptive fibres in the connective tissue, causing myalgic pain and tenderness. High estrogen-level, which gives a high expression of nitric oxide synthase in the muscle, accentuates the situation. During episodes of sustained inhibition of cytochrome oxidase by nitric oxide, peroxynitrite may be produced and cause irreversible inactivation of several enzymes in the mitochondrial electron-carrier chain. With repeated episodes, an increasing part of the enzymatic capacity for cellular respiration is inactivated. Even if this process only takes place within a small portion of the muscle fibres, it may contribute to frequent exacerbations of pain. Effects of peroxinitrite may also explain the mitochondrial abnormalities found in the trapezius muscle of many neck myalgia patients. Adrenergic antagonists and nitric oxide synthase inhibitors could reduce symptoms. Ascorbic, acid, alpha tocopherol, and flavonoids, which are safe and effective scavengers of peroxynitrite, could prevent chronicity. The most effective nonpharmacological measure may be to reduce exposure to prolonged head-down neck flexions and psychosocial stress at work. (C) 2004 Elsevier Ltd. All rights reserved.