The time course of disuse muscle atrophy of the lower limb in health and disease.
The time course of disuse muscle atrophy of the lower limb in health and disease.
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DOI：
10.1002/jcsm.13067
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发表时间：
2022-12
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影响因子：
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短期间歇性废用性肌肉萎缩（DMA）可能对年龄相关的肌肉损失产生负面影响。有证据表明，在肌肉之间和固定期间，DMA的速率存在差异。到目前为止，这一点还没有得到很好的描述。本综述旨在建立和比较DMA在健康和危重患者的固定人体下肢肌肉中的时程，探索DMA急性期和肌群之间萎缩率差异的证据。检索了MEDLINE、Embase、CINHAL和CENTRAL数据库，从开始到2021年4月，检索了报告多个固定后时间点的肌肉体积、横截面积（CSA）、结构或瘦腿质量的任何人体下肢固定研究。使用ROBINS‐I评估偏倚风险。在可能的情况下，使用DerSimonian和Laird随机效应模型进行Meta分析，效应量报告为不同时间点的平均差异（MD）和95%置信区间（95% CI），当无法进行Meta分析时，进行叙述性审查。纳入了29项研究，12项在健康志愿者中进行（总n = 140），18项在重症治疗室（ITU）患者中进行（总n = 516），3项在踝关节骨折患者中进行（总n = 39）。大多数纳入的研究存在中度偏倚风险。ITU患者（MD-1.01 95% CI-1.32，-0.69）在最初14天内的股四头肌萎缩率显著高于健康队列（MD-0.12 95% CI-0.49，0.24）（P < 0.001）。肌群之间的萎缩率似乎各不相同（小腿三头肌（第28天-11.2%）最高，其次是四头肌（第28天-9.2%），然后是腘绳肌（第28天-6.5%），然后是足背屈肌（第28天-3.2%））。随着时间的推移，健康的四头肌（第14天为−6.5%，第28天为−9.1%）、小腿三头肌（第14天为−7.8%，第28天为−11.2%）和ITU四头肌（第7天为−13.2%，第14天为−28.2%）的萎缩率似乎有所下降。肌群之间的DMA速率似乎存在变异性，并且在制动的最早期出现更快速的萎缩，表明不同的机制在不同的时间点占主导地位。严重不适的患者萎缩率更高。总体证据有限，现有数据在报告的措施中存在很大差异。需要进一步的工作来充分表征DMA在健康和疾病中的时间过程。
Short, intermittent episodes of disuse muscle atrophy (DMA) may have negative impact on age related muscle loss. There is evidence of variability in rate of DMA between muscles and over the duration of immobilization. As yet, this is poorly characterized. This review aims to establish and compare the time‐course of DMA in immobilized human lower limb muscles in both healthy and critically ill individuals, exploring evidence for an acute phase of DMA and differential rates of atrophy between and muscle groups. MEDLINE, Embase, CINHAL and CENTRAL databases were searched from inception to April 2021 for any study of human lower limb immobilization reporting muscle volume, cross‐sectional area (CSA), architecture or lean leg mass over multiple post‐immobilization timepoints. Risk of bias was assessed using ROBINS‐I. Where possible meta‐analysis was performed using a DerSimonian and Laird random effects model with effect sizes reported as mean differences (MD) with 95% confidence intervals (95% CI) at various time‐points and a narrative review when meta‐analysis was not possible. Twenty‐nine studies were included, 12 in healthy volunteers (total n = 140), 18 in patients on an Intensive Therapy Unit (ITU) (total n = 516) and 3 in patients with ankle fracture (total n = 39). The majority of included studies are at moderate risk of bias. Rate of quadriceps atrophy over the first 14 days was significantly greater in the ITU patients (MD −1.01 95% CI −1.32, −0.69), than healthy cohorts (MD −0.12 95% CI −0.49, 0.24) (P < 0.001). Rates of atrophy appeared to vary between muscle groups (greatest in triceps surae (−11.2% day 28), followed by quadriceps (−9.2% day 28), then hamstrings (−6.5% day 28), then foot dorsiflexors (−3.2% day 28)). Rates of atrophy appear to decrease over time in healthy quadriceps (−6.5% day 14 vs. −9.1% day 28) and triceps surae (−7.8% day 14 vs. −11.2% day 28), and ITU quadriceps (−13.2% day 7 vs. −28.2% day 14). There appears to be variability in the rate of DMA between muscle groups, and more rapid atrophy during the earliest period of immobilization, indicating different mechanisms being dominant at different timepoints. Rates of atrophy are greater amongst critically unwell patients. Overall evidence is limited, and existing data has wide variability in the measures reported. Further work is required to fully characterize the time course of DMA in both health and disease.
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影响因子：
2
作者：
Katari, Yeshaswini;Srinivasan, Rangalakshmi;Hiremathada, Sahajananda
通讯作者：
Hiremathada, Sahajananda
影响因子：
3.4
作者：
Bunnell A;Ney J;Gellhorn A;Hough CL
通讯作者：
Hough CL
影响因子：
2.4
作者：
Mendis, M. Dilani;Hides, Julie A.;Richardson, Carolyn
通讯作者：
Richardson, Carolyn
影响因子：
5.3
作者：
Heikkinen, Juuso;Lantto, Iikka;Leppilahti, Juhana
通讯作者：
Leppilahti, Juhana
影响因子：
3.1
作者：
Borges, Rodrigo Cerqueira;Soriano, Francisco Garcia
通讯作者：
Soriano, Francisco Garcia