Костно-мышечные нарушения у больных хронической обструктивной болезнью легких

В обзоре представлены данные о костно-мышечных нарушениях у больных хронической обструктивной болезнью легких (ХОБЛ). Рассматриваются основные факторы риска и патогенетические механизмы остеопороза и дисфункции периферических скелетных мышц у пациентов с ХОБЛ, такие как табакокурение, низкая физическая активность, воспаление, прием глюкокортикостероидов и т. п. Описано влияние низкого уровня витамина D на развитие и прогрессирование костно-мышечных нарушений у больных ХОБЛ, при этом особое внимание уделено саркопении и перекрестным синдромам – кахексии и немощности; показаны основные критерии диагностики, а также вопросы их дифференциации. Приводится разъяснение нового медицинского термина «остеосаркопения», обосновано исследование и оценка этого синдрома у пациентов с ХОБЛ.

1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2018 Report. Available at: https://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf

2. Barnes P.J., Celli B.R. Systemic manifestations and comorbidities of COPD. Eur. Respir. J. 2009; 33 (5): 1165–1185. DOI: 10.1183/09031936.00128008.

3. Parker C.M., Voduc N., Aaron S.D. et al. Physiological changes during symptom recovery from moderate exacerbations of COPD. Eur. Respir. J. 2005; 26 (3): 420–428. DOI: 10.1183/09031936.05.00136304.

4. Jackman R.W., Kandarian S.C. The molecular basis of skeletal muscle atrophy. Am. J. Physiol. Cell Physiol. 2004; 287 (4): 834–843. DOI: 10.1152/ajpcell.00579.2003.

5. Fabbri L.M., Luppi F., Beghe B., Rabe K.F. Complex chronic comorbidities of COPD. Eur. Respir. J. 2008; 31 (1): 204–212. DOI: 10.1183/09031936.00114307.

6. Jaramillo J.D., Wilson C., Stinson D.J. et al. Reduced bone density and vertebral fractures in smokers. Men and COPD patients at increased risk. Ann. Am. Thorac. Soc. 2015; 12 (5): 648–656. DOI: 10.1513/AnnalsATS.201412-591OC.

7. Leech J.A., Dulberg C., Kellie S. et al. Relationship of lung function to severity of osteoporosis in women. Am. Rev. Respir. Dis. 1990; 141 (1): 68–71. DOI: 10.1164/ajrccm/141.1.68.

8. Lombardi I. Jr, Oliveira L.M., Mayer A.F. et al. Evaluation of pulmonary function and quality of life in women with osteoporosis. Osteoporos Int. 2005; 16 (10): 1247–1253. DOI: 10.1007/s00198-005-1834-3.

9. Bon J., Fuhrman C.R., Weissfeld J.L. et al. Radiographic emphysema predicts low bone mineral density in a tobacco-exposed cohort. Am. J. Respir. Crit. Care Med. 2011; 183 (7): 885–890. DOI: 10.1164/rccm.201004-0666OC.

10. Jorgensen N.R., Schwarz P., Holme I. et al. The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease – A cross sectional study. Respir. Med. 2007; 101 (1): 177–185. DOI: 10.1016/j.rmed.2006.03.029.

11. Baron J.A., Comi R.J., Cryns V. et al. The effect of cigarette smoking on adrenal cortical hormones. J. Pharmacol. Exp. Ther. 1995; 272 (1): 151–155.

12. Kanis J.A., Johnell O., Oden A. et al. Smoking and fracture risk: a meta-analysis. Osteoporosis Int. 2005; 16 (2): 155–162. DOI: 10.1007/s00198-004-1640-3.

13. Law M.R., Hackshaw A.K. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture; recognition of a major effect. Br. Med. J. 1997; 315 (7112): 841–846. DOI: 10.1136/bmj.315.7112.841.

14. Nelson H.D., Nevitt M.C., Scott J.C. et al. Smoking, alcohol, and neuromuscular and physical function of older women. Study of Osteoporotic Fractures Research Group. JAMA. 1994; 272 (23): 1825–1831.

15. Biskobing D.M. COPD and osteoporosis. Chest. 2002; 121 (2): 609–620.

16. 1983 metropolitan height and weight tables. Stat. Bull. Metrop. Life Found. 1983; 64 (1): 3–9.

17. Schols A.M., Soeters P.B., Dingemans A.M. et al. Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am. Rev. Respir. Dis. 1993; 147 (5): 1151–1156. DOI: 10.1164/ajrccm/147.5.1151.

18. Jones A., Fay J.K., Burr M. et al. Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease. Сochrane Database Syst. Rev. 2002; (1): CD003537. DOI: 10.1002/14651858.CD003537.

19. Jorgensen N.R., Schwarz P., Holme I. et al. The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study. Respir. Med. 2007; 101 (1): 177–185. DOI: 10.1016/j.rmed.2006.03.029.

20. Jain R.K., Vokes T. Physical activity as measured by accelerometer in NHANES 2005–2006 is associated with better bone density and trabecular bone score in older adults. Arch. Osteoporos. 2019; 14: 29. DOI: 10.1007/s11657-019-0583-4.

21. Le Jemtel T.H., Padeletti M., Jelic S. Diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure. J. Am. Coll. Cardiol. 2007; 49 (2): 171–180. DOI: 10.1016/j.jacc.2006.08.046.

22. Adler R.A., Funkhouser H.L., Petkov V.I. et al. Osteoporosis in pulmonary clinic patients. Does point-of-care screening predict central dual-energy X-ray absorptiometry? Chest. 2003; 123 (6): 2012–2018.

23. Mannino D.M., Buist A.S. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007; 370 (9589): 765–773. DOI: 10.1016/S0140-6736(07)61380-4.

24. Москаленко В.Д. Медицинские последствия наркомании и алкоголизма. Наркология. 2007. (7): 52–54.

25. Sisson J.H. Alcohol and airways function in health and disease. Alcohol. 2007; 41 (5): 293–307. DOI: 10.1016/j.alcohol.2007.06.003.

26. Maurer D.R., Liebman J. Effects of ethanol on in vitro ciliary motility. J. Appl. Physiol. 1985; 65 (4): 1617–2000. DOI: 10.1152/jappl.1988.65.4.1617.

27. Лесняк О.М., Евстигнеева Л.П., Кузьмина Л.И. и др. Эпидемиология переломов позвоночника и периферических костей в старших возрастных группах жителей г. Екатеринбурга. Остеопороз и остеопатии. 1999; (2): 2–4.

28. Евстигнеева Л.П., Лесняк О.М., Пивень А.И. Эпидемиология остеопоротических переломов позвоночника по данным рентгеноморфометрического анализа среди популяционной выборки жителей г. Екатеринбурга 50 лет и старше. Остеопороз и остеопатии. 2001; (2): 2–6.

29. Торопцова Н.В., Баранова И.А. Глюкокортикоидный остеопороз: особенности терапии. Современная ревматология. 2013; 7 (4): 33–37. DOI: 10.14412/1996-7012-2013-2436.

30. Lukert B.P., Johnson B.E., Robinson R.G. Estrogen and progesterone replacement therapy reduces glucocorticoid-induced bone loss. J. Bone Miner. Res. 1992; 7 (9): 1063–1069. DOI: 10.1002/jbmr.5650070909.

31. Laan R.F., van Riel P.L., van de Putte L.B. et al. Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis. A randomized, controlled study. Ann. Intern. Med. 1993; 119 (10): 963–968.

32. Van Staa T.P., Leufkens H.G., Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002; 13 (10): 777–787. DOI: 10.1007/s001980200108.

33. Kanis J.A., Johansson H., Oden A. et al. Meta-analysis of prior corticosteroid use and fracture risk. J. Bone Miner. Res. 2004; 19 (6): 893–899. DOI: 10.1359/JBMR.040134.

34. Holick M.F., Binkley N.C., Bischoff-Ferrari H.A. et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 2011; 96 (7): 1911–1930. DOI: 10.1210/jc.2011-0385.

35. Lips P. Vitamin D physiology. Prog. Biophys. Mol. Biol. 2006; 92 (1): 4–8. DOI: 10.1016/j.pbiomolbio.2006.02.016.

36. Janssens W., Lehouck A., Carremans C. et al. Vitamin D beyond bones in chronic obstructive pulmonary disease. Time to act. Am. J. Respir. Crit. Care Med. 2009; 179 (8): 630–636. DOI: 10.1164/rccm.200810-1576PP.

37. Hughes D.A., Norton R. Vitamin D and respiratory health. Clin. Exp. Immunol. 2009; 158 (1): 20–25. DOI: 10.1111/j.1365-2249.2009.04001.x.

38. Quint J.K., Wedzicha J.A. Is vitamin D deficiency important in the natural history of COPD? Thorax. 2010; 65 (3): 192–194. DOI: 10.1136/thx.2009.129619.

39. Ginde A.A., Mansbach J.M., Camargo C.A. Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the third national health and nutrition examination survey. Arch. Intern. Med. 2009; 169 (4): 384–390. DOI: 10.1001/archinternmed.2008.560.

40. Geusens P., Goldring S.R., Briot K., Roux С. Chapter 11 – The role of the immune system in the development of osteoporosis and fracture risk. In: Lorenzo J., ed. Osteoimmunology: Interactions of the Immune and Skeletal Systems. The 2nd Edition. 2016: 187–214. DOI: 10.1016/B978-0-12-800571-2.00011-6.

41. Баранова И.А., Торопцова Н.В. Новые аспекты в диагностике и лечении глюкокортикоидного остеопороза. Остеопороз и остеопании. 2013; 16 (3): 36–40.

42. Maltais F., Decramer M., Casaburi R. et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2014; 189 (9): е15–62. DOI: 10.1164/rccm.201402-0373ST.

43. Seymour J.M., Spruit M.A., Hopkinson N.S. et al. The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur. Respir. J. 2010; 36 (1): 81–88. DOI: 10.1183/09031936.00104909.

44. Spruit M.A., Gosselink R., Troosters T. et al. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax. 2003; 58 (9): 752–756.

45. Vilaro´ J., Ramirez-Sarmiento A., Mart´ınez-Llorens J.M. et al. Global muscle dysfunction as a risk factor of readmission to hospital due to COPD exacerbations. Respir. Med. 2010; 104 (12): 1896–1902. DOI: 10.1016/j.rmed.2010.05.001.

46. Yun Z., Lin Q., Giaccia A.J. Adaptive myogenesis under hypoxia. Mol. Cell. Biol. 2005; 25 (8): 3040–3055. DOI: 10.1128/MCB.25.8.3040-3055.2005.

47. England B.K., Chastain J.L., Mitch W.E. Abnormalities in protein synthesis and degradation induced by extracellular pH in BC3H1 myocytes. Am. J. Physiol. 1991; 260 (2): 277–282. DOI: 10.1152/ajpcell.1991.260.2.C277.

48. Decramer M., de Bock V., Dom R. Functional and histologic picture of steroid-induced myopathy in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1996; 153 (6, Pt 1): 1958–1964. DOI: 10.1164/ajrccm.153.6.8665061.

49. Schakman O., Gilson H., Kalista S., Thissen J.P. Mechanisms of muscle atrophy induced by glucocorticoids. Horm. Res. 2009; 72 (Suppl. 1): 36–41. DOI: 10.1159/000229762.

50. Sohl E., van Schoor N.M., de Jongh R.T. et al. Vitamin D status is associated with functional limitations and functional decline in older individuals. J. Clin. Endocrinol. Metab. 2013; 98 (9): 1483–1490. DOI: 10.1210/jc.2013-1698.

51. Evans W.J., Morley J.E., Argilés J. et al. Cachexia: a new definition. Clin. Nutr. 2008; 27 (6): 793–799. DOI: 10.1016/j.clnu.2008.06.013.

52. Fried L.P., Tangen C.M., Walston J. et al. Frailty in older adults: Evidence for a phenotype. J. Gerontol. 2001; 56A (3): M146–M156.

53. Cruz-Jentoft A.J., Bahat G., Bauer J. et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48 (1): 16–31. DOI: 10.1093/ageing/afy169.

54. Jones S.E., Maddocks M., Kon S.S.C. et al. Sarcopenia in COPD: prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax. 2015; 70 (3): 213–218. DOI: 10.1136/thoraxjnl-2014-206440.

55. Maddocks M., Kon S.S.С., Canavan J.L. et al. Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study. Thorax. 2016; 71 (11): 988–995. DOI: 10.1136/thoraxjnl-2016-208460.

56. Walsh M.C., Hunter G.R., Livingstone M.B. Sarcopenia in premenopausal and postmenopausal women with osteopenia, osteoporosis and normal bone mineral density. Osteoporosis Int. 2006; 17 (1): 61–67. DOI: 10.1007/s00198-005-1900-x.

57. Demontiero O., Boersma D., Suriyaarachchi P., DuqueG. Clinical outcomes of impaired muscle and bone interactions. Clin. Rev. Bone Miner. Metab. 2014; 12 (2): 86–92. DOI: 10.1007/s12018-014-9164-7.

58. Mera P., Laue K., Ferron M. et al. Osteocalcin signaling in myofibers is necessary and sufficient for optimum adaptation to exercise. Cell Metab. 2016; 23 (6): 1078–1092. DOI: 10.1016/j.cmet.2016.05.004.

59. Tagliaferri C., Wittrant Y., Davicco M.J. et al. Muscle and bone, two interconnected tissues. Ageing Res. Rev. 2015; 21: 55–70. DOI: 10.1016/j.arr.2015.03.002.