慢性肾脏病诱导骨骼肌萎缩的临床研究进展

Progress in clinical research on skeletal muscle atrophy induced by chronic kidney disease

摘要:

慢性肾脏病（CKD）患者大多存在蛋白质能量消耗，主要表现为骨骼肌萎缩。骨骼肌萎缩与CKD患者的生活质量及不良预后密切相关。但其发生机制尚不明确，包括蛋白质摄入减少、泛素-蛋白酶体系统的激活、卫星细胞功能异常、RNA调控、代谢性酸中毒、炎症因子影响、激素紊乱等，这些因素导致整个机体合成代谢减弱、分解代谢增加，最终导致骨骼肌进行性消耗，出现肌无力，肌萎缩等症状。骨骼肌萎缩的干预措施有许多，且因人而异。该综述主要对CKD导致骨骼肌萎缩的机制、表现及治疗进行整理，介绍近年来国内外对CKD研究的治疗和预防新进展，旨在帮助医师早期识别，及时干预，以及改善患者预后。

Abstract:

The protein-energy wasting (PEW) in most patients with chronic kidney disease (CKD) is mainly manifested as skeletal muscular dystrophy, which is closely related to the quality of life and adverse prognosis of these patients. The pathogenesis of skeletal muscular dystrophy is still not clear, though an inadequate intake of protein, the activation of ubiquitin-proteasome system (UPS), satellite cell dysfunction, RNA dysregulation, metabolic acidosis, inflammatory factors, and hormonal disorders are considered involved. These factors lead to the weakening of the anabolism and strengthening of catabolism, and eventually the progressive loss of skeletal muscle, presenting muscle weakness and atrophy. There are many interventions for skeletal muscle atrophy and they may vary from person to person. This review mainly summarizes the pathogenesis, manifestations and treatment of skeletal muscle atrophy induced by CKD, and introduces the advances in the treatment and prevention of CKD in recent years, aiming to facilitate the early identification and intervention of the disease to improve the prognosis.