ACR：神经肌肉损伤是纤维肌痛综合征患者功能受限的重要因素

来自法国格勒诺布尔约瑟夫傅立叶大学的DAMIEN BACHASSO等人进行了一项研究，该研究的目的是通过磁性股神经刺激（FNMS）来评价纤维肌痛综合征（FMS）和健康人的股四头肌肌力及劳损情况，及其与运动能力的关系。研究结果在线发布在2013年3月的《关节炎护理及研究》（Arthritis Care & Research）杂志上。作者发现，FMS患者的肌肉收缩损伤大与劳累感提高和最大运动能力减低有关。神经肌肉损伤应被看做是FMS患者功能受限的一个重要因素。
该研究共招募了22位女性研究对象（11位FMS患者、11位健康对照）。研究包括两个独立访视期，研究对象在每个访视分别接受最大增量循环试验和股四头肌疲劳测试。在股四头肌测评方面，研究者在最大随意收缩（MVC）过程中和之后都采用FNMS来评价神经肌肉疲劳的中枢和外周因素。受试者做了10次间歇性的等长收缩（5秒开始/5秒关闭），每次从10%MVC开始，从第一次的10MVC开始逐渐增加至下一次，直至结束。每一次结束后均采用FNMS评估神经肌肉疲劳。
研究结果如下，FMS患者的起始MVC比对照组降低（均数±标准差：102 ± 18  vs 120±24 Nm；P < 0.05）；但是，FMS患者的随意刺激无显著损伤（均数±标准差：93.5% ± 3.0%  vs 93.1% ± 3.4%；P =0.74）。在疲劳负荷中，FMS患者在肌肉诱发反应中表现出更多下降（在50% MVC时，均数±标准差：-26% ± 6% vs  -16% ± 8%；P < 0.05），但MVC未表现出显著差异（在50% MVC时，均数±标准差：-24% ± 7% vs -19% ± 4% ；P=0.12）。在循环测试中，FMS患者的最大运动能力比对照组低，但劳累感知评级（RPE）比对照组高。股四头肌疲劳试验中表现出的肌肉诱发反应降低的比例与最大氧耗量相一致（r =0.56，P < 0.05），且与循环试验中亚强度下的RPE相一致（r =0.84, P < 0.05）。
研究发现，FMS患者的肌肉收缩损伤大与劳累感知提高和最大运动能力减低有关。神经肌肉损伤应被看做是FMS患者功能受限的一个重要因素。

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Neuromuscular fatigue and exercise capacity in fibromyalgia syndrome.
OBJECTIVE
To assess quadriceps strength and fatigability by using femoral nerve magnetic stimulation (FNMS) and their relationship to exercise capacity in patients with fibromyalgia syndrome (FMS) and healthy controls.
METHODS
Twenty-two women (11 with FMS, 11 controls) performed a maximal incremental cycling test and a quadriceps fatigue test on 2 separate visits. For quadriceps assessment, we used FNMS during and after maximum voluntary contraction (MVC) to evaluate central and peripheral factors of neuromuscular fatigue. Subjects performed sets of 10 intermittent (5 seconds on/5 seconds off) isometric contractions starting at 10% MVC, in 10% MVC increments from one set to another until exhaustion. Neuromuscular fatigue was assessed with FNMS after each set.
RESULTS
FMS patients had reduced initial MVC compared to controls (mean ± SD 102 ± 18 versus 120 ± 24 Nm; P < 0.05) without significant impairment of voluntary activation (mean ± SD 93.5% ± 3.0% versus 93.1% ± 3.4%; P = 0.74). During the fatigue task, FMS patients exhibited a greater fall in evoked muscular responses (mean ± SD -26% ± 6% versus -16% ± 8% at set 50% MVC; P < 0.05), but not in MVC (mean ± SD -24% ± 7% versus -19% ± 4% at set 50% MVC; P = 0.12). During the cycling test, FMS patients had lowered maximal exercise capacity and an enhanced rate of perceived exertion (RPE) compared to controls. The percent reduction in evoked muscular responses during the quadriceps fatigue test correlated with maximum oxygen consumption (r = 0.56, P < 0.05) and RPE at submaximal intensity (r = 0.84, P < 0.05) during cycling.
CONCLUSION
Greater impairment in muscle contractility is associated with enhanced perception of exertion and reduced maximal exercise capacity in FMS patients. Neuromuscular impairments should be considered as an important factor underlying functional limitations in FMS patients.