Preliminary evidence for cachexia in patients with well-established ankylosing spondylitis
Preliminary evidence for cachexia in patients with well-established ankylosing spondylitis
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DOI：
10.1093/rheumatology/kel127
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发表时间：
2006-11-01
期刊：
影响因子：
5.5
通讯作者：
Lemmey, A.
中科院分区：
文献类型：
--
作者：
Marcora, S.;Casanova, F.;Lemmey, A.
目标。恶病质，定义为慢性炎症反应背景下骨骼肌的加速丧失，在类风湿关节炎中很常见，但在强直性脊柱炎(AS)患者中尚未发现。这项研究的目的是确定一组公认的AS患者的肌肉萎缩及其功能后果。19名男性患者(平均年龄53岁)患有长期AS(平均病程19年)和放射学改变(84%有一个或多个关节突)，与19名年龄匹配、有相似习惯性体力活动水平的健康男性进行比较。采用双能X线骨密度仪测定人体成分。肌力测定采用等速伸膝和握力测功，30例采用S屈臂和坐立试验。与健康对照组相比，患者的手臂和腿部瘦质量(衡量全身骨骼肌质量的替代指标)在统计学和临床上显著减少了12%(P<；0.05)。这种肌肉损失与上半身和下半身力量的下降显著相关(相关系数在0.37到0.79之间，P<；0.05)。这些结果提供了初步证据，表明恶病质是AS的一种功能相关的全身性并发症，特别是在有长期疾病和放射学改变的患者中。渐进式阻力训练和其他旨在刺激骨骼肌生长的干预措施可能对这一人群有益，需要对AS患者恶病质的病理生理学进行进一步研究。
Objectives. Cachexia, defined as an accelerated loss of skeletal muscle in the context of a chronic inflammatory response, is common in rheumatoid arthritis but it has not been demonstrated in patients with ankylosing spondylitis (AS). The aim of this study was to determine muscle wasting and its functional consequences in a group of patients with well-established AS.Methods. Nineteen male patients (mean age 53 yrs) with long-standing AS (mean disease duration 19 yrs) and radiological changes (84% had one or more syndesmophytes) were compared with 19 age-matched healthy males with similar levels of habitual physical activity. Body composition was assessed by dual energy X-ray absorptiometry. Muscle strength was measured by isokinetic knee extension and hand grip dynamometry, and by 30 s arm curl and chair sit-to-stand tests.Results. AS patients showed a statistically and clinically significant 12% reduction in arms and legs lean mass, a proxy measure of total body skeletal muscle mass, compared with healthy controls (P < 0.05). This muscle loss was significantly associated with reduced upper and lower body strength (correlation coefficients ranging between 0.37 and 0.79, P < 0.05).Conclusion. These results provide preliminary evidence that cachexia is a functionally relevant systemic complication of AS, particularly in patients with long-standing disease and radiological changes. Progressive resistance training and other interventions aimed at stimulating skeletal muscle growth might be beneficial in this population, and further studies on the pathophysiology of cachexia in AS patients are needed.