Структурно-метаболические изменения скелетных мышц у пациентов с хроническим нарушением сознания – к вопросу о полинейромиопатиях критических состояний (ПЭТ-патоморфологическое исследование)

Abstract

The presence of patients in a state of chronic disorders consciousness leads to the development of dysfunction (weakness, paresis) of their skeletal muscles – polyneuropathy and myopathy of critical states. It is of interest to study the mechanisms of pathology development and assess the rehabilitation potential of such patients. Positron emission computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) and pathomorphological studies with immunohistochemistry were used to obtain data on structural and metabolic changes in the skeletal muscles of the upper extremities in 22 patients with chronic disorders consciousness. The study showed that structural changes in skeletal muscles have a non-specific degenerative-atrophic character with more pronounced manifestations on the side of paresis. The metabolic disorders of the shoulder girdle muscles revealed by the decrease in the level of 18F-FDG metabolism in patients with chronic disorders consciousness developed symmetrically, regardless of the degree of decrease in muscle tone and deep reflexes. Along with degenerative changes, including damage to the contractile elements of sarcomeres, loss of desmin and dystrophin, a decrease in the level of 18F-FDH metabolism, signs of adaptive structural and functional rearrangements were observed in the skeletal muscles of patients- modification of the phenotype of muscle fibers by the fast type and activation of the autophagic pathway.