Общие патогенетические механизмы развития саркопении при хронической болезни почек и метаболических нарушениях

Саркопения – это синдром, характеризующийся прогрессирующей генерализованной потерей массы, силы и работоспособности (выносливости) скелетной мускулатуры, что ведет к увеличению риска неблагоприятных исходов, особенно среди пожилых пациентов, таких как низкое качество жизни, инвалидизация и смерть. Хроническая болезнь почек (ХБП) представляет собой состояние, способствующее ускоренному старению, что может стимулировать нарушения функционального и нутритивного статуса, предрасполагающие пациентов с ХБП к более высокому риску развития саркопении, особенно в терминальной стадии болезни почек. Саркопения является одним из гериатрических синдромов, и ХБП считается одним из ее факторов риска, главным образом за счет развития метаболических нарушений и системного воспаления. Среди патогенетических факторов саркопении выделяют следующие: нарушение работы митохондрий, возрастное снижение концевых пластинок мотонейронов, избыточный апоптоз, сниженная продукция оксида азота, низкий уровень андрогенов, сниженная активность сателлитных и стволовых клеток, системное воспаление, прием глюкокортикоидов. ХБП связана с нарушением метаболизма и гормонального статуса, включая ацидоз, уремию, гиперпаратиреоз и повышение инсулиноподобного фактора роста (ИФР), которые влияют на функциональность мышц и риски развития саркопении. Дисбактериоз кишечника рассматривается как еще один механизм, участвующий в прогрессировании ХБП, и может быть косвенно связан со состоянием мышц. В ряде работ установлена взаимосвязь между потерей мышечной массы и ухудшением функции почек, в том числе при саркопеническом ожирении. Мышечная масса является ключевым фактором долголетия у пожилых людей, а саркопения, вызванная ожирением, является значительным фактором риска неблагоприятных последствий для здоровья. Однако частота саркопенического ожирения в популяции с ХБП изучена недостаточно. Систематические обзоры показали, что саркопения у пациентов с ХБП была связана с несколькими неблагоприятными клиническими исходами, такими как падения, переломы, сердечно-сосудистые события. Несмотря на обилие исследований, изучающих вышеупомянутые процессы, точные молекулярные пути и взаимодействия, приводящие к мышечной атрофии, не были изучены в достаточной степени. Систематических обзоров и метаанализов, обобщающих распространенность саркопении при ХБП, мало, и они в основном ограничены пациентами, находящимися на диализе, и реципиентами трансплантата почки.

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