Morfometría fibrilar del músculo intercostal externo. Comparación entre los lados dominante y no dominante en pacientes con EPOC severa

Jiménez-Fuentes, M.A.; Gea, J.; Pallás, O.; Gallego, F.; Félez, M.A.; Broquetas, J.M.

doi:10.1016/S0300-2896(15)30451-8

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

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Las características generales de la morfometría del músculo intercostal externo (IE) de pacientes con patología respiratoria crónica han sido ampliamente descritas. Por su accesibilidad, este músculo puede ser un modelo ideal en estudios longitudinales utilizando biopsias consecutivas de ambos lados. Sin embargo, se desconoce si existe o no homogeneidad en el fenotipo fibrilar del IE entre el lado dominante (D) y el no dominante (ND). Se han evaluado las posibles diferencias estructurales del IE entre ambos lados en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Se incluyeron 8 enfermos (63±7 años), en los que se evaluaron la función pulmonar, fuerza muscular respiratoria, fuerza muscular general y estado nutricional. También se practicó biopsia del quinto IE de ambos lados. Las muestras fueron procesadas en paralelo para morfometría convencional (tinción de hematoxilina-eosina), valorándose el diámetro mínimo (Din) y el área fibrilar (Ar) en cortes transversales. La tipificación de las fibras se realizó mediante las tinciones de ATPasa (a pH de 4,2, 4,6 y 9,4) y NADH-TR. El estudio nutricional fue normal en todos los casos. Los sujetos estudiados presentaban una EPOC severa (FEV1, = 27±7%, ref., límites entre 13 y 38% ref.), con atrapamiento aéreo (RV = 163±36% ref., límites entre 181 y 276% ref.). Ninguno de los pacientes incluidos presentaba insuficiencia respiratoria en reposo (PaO2 72 ±7 mmHg). El estudio de fuerza esquelética periférica mediante dinamometría manual presentó valores muy similares entre ambos lados: D = 29±2 y ND = 28±3 dinas (NS). En el estudio morfométrico de las 16 muestras musculares se observaron tamaños fibrilares similares entre los lados D y ND. Respectivamente, DmD 47±10 μm y ArD 2.595±1.249 μm2, frente a DmND y ArND de 49±9μm y 2.636±953 μm2 (NS en ambos casos). En cuanto a la tipificación fibrilar tampoco se encontraron diferencias significativas entre el IE dominante y el no dominante: tipo ID 51±4% y tipo IID 49±5% frente a tipo IND 52±4% y tipo IIND 48±4% (NS). Existe homogeneidad morfométrica entre el fenotipo fibrilar del músculo IE del lado dominante y el no dominante en el quinto espacio intercostal. Este hecho y la escasa invasividad de la técnica permiten plantear estudios longitudinales sobre los efectos estructurales que diferentes intervenciones farmacológicas o físicas puedan tener sobre el IE de pacientes con EPOC.

Palabras clave:

Estructura

Músculos respiratorios

EPOC

The general morphometric characteristics of the external intercostal muscle (EIM) of patients with chronic respiratory disease have been well described. Because this muscle is highiy accessibile, it can provide an ideal model for longitudinal studies using consecutive biopsies of both sides. Whether or not the EIM fíber phenotype is homogeneous on dominant (D) and non dominant (ND) sides is unknown, however.

To evalúate possible stuctural differences in right and left EIM in patients with COPD, eight patients (63±7 years of age) were enrolled. Lung function, respiratory muscle power, general muscle power and nutritional state were evaluated. Biopsies of the fifth EIM were taken from both sides. Specimens were processed in parallel manner to determine conventional morphometry (hematoxyllin-eosin staining), including minimum diameter (Dm) and fiber área (Ar) in cross sections. Fibers were typed by ATPase (at pH 4.2,4.6 and 9.4) and NADH-TR staining.

Nutrition was normal in all patients. All patients had severe COPD (FEV1 27±7% of reference, limits 13 to 38% of reference) with air entrapment (RV 163±36% of reference, limits 181 to 276% of reference). None of the patients showed respiratory insufficiency at rest (PaO2 72 ±7 mmHg). Peripheral musculoskeletal power measured by manual dynamonieter showed no significant right-left differences: D 29±2 and ND 28±3 dynes. Morphometric study of 16 muscle specimens showed no significant differences between fiber size on D and ND sides. DmD was 47±10 μm and ArD was 2,595±1,249 μm2. DmND was 49±9 μm and ArND was 2,636±953 μm2. Likewise, no significant differences were found between D and ND fiver types: type ID 51±4% and type IID 49±5% versus type IND 52±4% and type IIND48 ±4%.

EIM on N and ND sides is homogeneous at the fifth intercostal space. This finding, along with the scarcely invasive nature of the technique for collecting specimens leads us to suggest that longitudinal studies might be performed on the structural effects of various pharmacological or physical treatments followed by COPD patients.

Key words:

Structure

Respiratory muscles

COPD

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