Muscle atrophy in patients receiving hemodialysis: Effects on muscle strength, muscle quality, and physical function
Muscle atrophy in patients receiving hemodialysis: Effects on muscle strength, muscle quality, and physical function
复制标题
DOI：
10.1046/j.1523-1755.2003.00704.x
复制
发表时间：
2003-01-01
影响因子：
19.6
通讯作者：
Kent-Braun, JA
中科院分区：
文献类型：
--
作者：
Johansen, KL;Shubert, T;Kent-Braun, JA
背景与肾功能正常的个体相比，透析患者活动较少，功能能力降低。肌肉萎缩和无力可能导致这些问题。本研究旨在量化下肢肌肉萎缩的程度，以确定是否存在肌肉比强度（单位质量的力）或中枢神经系统（CNS）激活的缺陷，并评估一组血液透析患者肌肉大小和身体表现之间的关系。入组了38名透析受试者（年龄55 ± 15岁）和19名健康久坐对照者（年龄55 ± 13岁）。小腿的磁共振成像用于确定踝背屈肌的总横截面积（CSA）和收缩和非收缩组织的面积。在有和没有叠加强直刺激的最大自主收缩期间测量等长背屈肌强度（透析受试者N = 22，对照组N = 12）。通过加速度计测量身体活动，并记录步态速度作为身体表现的量度。透析受试者比对照组更虚弱，活动更少，行走更慢。透析受试者和对照组之间的总肌间室CSA无显著差异，但即使在调整年龄、性别和体力活动后，透析患者的收缩性CSA也较小。中枢激活和比强度正常。步态速度与收缩性CSA相关。血液透析患者的肌肉中存在显著萎缩和非收缩性组织增加。收缩面积和强度之间的关系在该人群中是完整的。肌肉萎缩与身体表现不佳有关。因此，增加体力活动或以其他方式解决萎缩的干预措施可以改善表现和生活质量。
Background. Dialysis patients are less active and have reduced functional capacity compared to individuals with normal renal function. Muscle atrophy and weakness may contribute to these problems. This investigation was undertaken to quantify the extent of atrophy in the lower extremity muscles, to determine whether defects in muscle specific strength (force per unit mass) or central nervous system (CNS) activation are present, and to assess the relationship between muscle size and physical performance in a group of patients on hemodialysis.Methods. Thirty-eight dialysis subjects (aged 55 +/- 15 years) and nineteen healthy sedentary controls (aged 55 +/- 13 years) were enrolled. Magnetic resonance imaging of the lower leg was used to determine the total cross-sectional area (CSA) and the area of contractile and non-contractile tissue of the ankle dorsiflexor muscles. Isometric dorsiflexor strength was measured during a maximal voluntary contraction with and without superimposed tetanic stimulation (N = 22 for dialysis subjects, N = 12 for controls). Physical activity was measured by accelerometry, and gait speed was recorded as a measure of physical performance.Results. Dialysis subjects were weaker, less active, and walked more slowly than controls. Total muscle compartment CSA was not significantly different between dialysis subjects and controls, but the contractile CSA was smaller in the dialysis patients even after adjustment for age, gender, and physical activity. Central activation and specific strength were normal. Gait speed was correlated with contractile CSA.Conclusions. Significant atrophy and increased non-contractile tissue are present in the muscle of patients on hemodialysis. The relationship between contractile area and strength is intact in this population. Muscle atrophy is associated with poor physical performance. Thus, interventions to increase physical activity or otherwise address atrophy may improve performance and quality of life.