alcoholic myopathy
Introduction
Introduction to alcoholic toxic myopathy Alcoholic myopathy (alcoholic myopathy), also known as alcoholic myopathy, is a muscle lesion caused by alcoholism and whose pathogenesis is unknown. Clinical manifestations can be acute myopathy and chronic myopathy, the severity is related to the amount of alcohol consumed. basic knowledge Sickness ratio: 0.0001% Susceptible people: long-term drinkers Mode of infection: non-infectious Complications: chronic alcoholism, peripheral neuropathy, hypotension, shock, arrhythmia, atrial fibrillation
Cause
Causes of alcoholic myopathy
(1) Causes of the disease
Patients with this disease have a long history of heavy drinking, and alcoholic myopathy is closely related to alcohol toxicity, but its pathogenesis is still unclear.
(two) pathogenesis
Its pathogenesis is unclear, and speculation may be related to the following factors:
1. Alcohol and acetaldehyde reduce the activity of glycolytic enzymes and inhibit the metabolism of sugars.
2. Alcohol and metabolite acetaldehyde is toxic to muscle cells, causing toxic damage to the muscle sheath and mitochondria, mitochondrial dysfunction, or blocking actin and myoglobin kinases, preventing troponin binding and disrupting Cell structure, affecting cell trafficking, leading to muscle cell damage.
3. Reduce free fatty acids in the main oxidized matrix of skeletal muscle.
4. There are hypokalemia, hyponatremia, hypophosphatemia, hypocalcemia and hypomagnesemia and other metabolic abnormalities, as well as vitamin B deficiency, causing secondary damage to the muscles.
5. Patients with alcoholism who have seizures, tremors, convulsions and high fever can increase physical activity and muscle cell metabolism, leading to muscle cell damage; seizures and limb compression can induce rhabdomyolysis.
The pathological manifestations of chronic myopathy are type II fiber atrophy, muscle fiber size is different, acute myopathy is muscle necrosis, with or without inflammation, muscle fiber regeneration, type I fiber atrophy.
Prevention
Alcoholic toxic myopathy prevention
Promote the harm of alcohol to the human body, improve the cultural quality of the whole nation, strictly enforce the law on minors, strictly prohibit the drinking of minors, strengthen legal supervision, attach importance to and strengthen the mental health propaganda of wine, promote civilized drinking, do not persuade alcohol, do not drink alcohol, Do not drink on an empty stomach, treat physical or mental illnesses, avoid alcohol substitutes, promote the use of beverages to replace alcohol, reduce alcohol dependence caused by occupational reasons, promote the production of low-alcohol, control and ban the production of spirits, and crack down on illegal acts of illegal counterfeiting .
Complication
Alcoholic toxic myopathy complications Complications chronic alcoholism peripheral neuropathy hypotension shock arrhythmia atrial fibrillation
1. Severe cases of renal failure due to massive muscle necrosis.
2. Chronic alcoholic toxic myopathy often associated with peripheral neuropathy.
3. Also seen in the myocardium, arrhythmia, hypotension and cardiogenic shock, arrhythmia, atrial fibrillation and other "holiday heart" syndrome can occur during the holiday.
Symptom
Alcoholic toxic myopathy symptoms Common symptoms Lower extremity swelling and fatigue After walking, calf muscle spasm excess drinking two times... Symmetrical muscle weakness, calf, ankle muscle pain... Alcoholic limb pain
Acute myopathy
This is a serious and life-threatening disease. It occurs in patients with chronic alcoholism who have been drinking alcohol for a long time. It is more acute after an excessive drinking. It is characterized by sudden onset of paralysis and pain in both lower extremities, fatigue, edema and tenderness. Systemic or confined to a limb with reduced or absent reflexes.
There may be myosinuria, serum creatine phosphokinase (CPK) activity increased, can lead to acute renal failure, hyperkalemia and death, muscle biopsy showed acute rhabdomyolysis, EMG often shows the performance of primary myopathy.
2. Chronic myopathy
This is a proximal muscle weakness and muscle wasting disease caused by long-term drinking. It is a chronic, painless muscle lesion with bilateral symmetrical muscle weakness and muscle atrophy. It can be light and heavy, most often involved. Pelvic band and thigh muscles, scapular muscle weakness is rare, this disease often coincides with alcoholic peripheral neuropathy.
Examine
Alcoholic toxic myopathic examination
1. Elevated creatine kinase (CK) is a specific indicator of muscle damage sensitivity.
2. Other blood tests include blood biochemistry, kidney function, liver function, coagulation function and immunoglobulin.
3. The determination of blood and urine alcohol concentration has the significance of diagnosis and evaluation of the degree of alcoholism.
4. ECG, EEG, brain CT or MRI examination, there is a differential diagnosis and the significance of the degree of poisoning assessment.
5. Electromyography and neurophysiological examination have differential diagnosis significance.
Diagnosis
Diagnosis and diagnosis of alcoholic myopathy
According to the history of drinking, typical clinical symptoms, signs, serum CPK, aldolase increase, is not difficult to diagnose acute myopathy, serum enzyme levels and electromyography are helpful to confirm the diagnosis, creatine kinase (CK) is elevated Specific indicators of muscle damage sensitivity, muscle cell damage release muscle protein is quickly cleared from the kidney, muscle proteinuria only lasts for several hours, the sensitivity of muscle proteinuria to the diagnosis of muscle damage is only about 18%, muscle biopsy is feasible in individual cases.
Chronic myopathy should be differentiated from endocrine myopathy, electrolyte imbalance, poisoning and other myopathy, as well as inflammatory peripheral neuropathy.
