【 文献重点摘要 】
 

Botulinum toxin type A (BTX-A) is a frequently used treatment modality for a variety of neuromuscular disorders. It acts by preventing acetylcholine release at the motor nerve endings, inducing muscle paralysis. Although considered safe, studies suggest that BTX-A injections create adverse effects on target and non-target muscles. We speculate that these adverse effects are reduced by direct electrical stimulation (ES) exercising of muscles. The aims were to determine the effects of ES exercise on strength, mass, and contractile material in BTX-A injected muscles, and to investigate if BTX-A injections affect non-target muscles. Seventeen New Zealand White (NZW) rabbits were divided into three groups: (1) Control group received saline injections; (2) BTX-A group received monthly BTX-A (3.5 U/kg) injections into the quadriceps for six months and (3) BTX-AþES group received monthly BTX-A injections and ES exercise three times a week for six months. Outcome measures included knee extensor torque, muscle mass, and contractile material percentage area in injected and contralateral, non-injected quadriceps. Glycogen depletion and direct muscle stimulation were used to assess possible muscle inhibition in non-injected quadriceps. ES exercise partially prevented muscle weakness, atrophy, and contractile material loss in injected muscles, and mostly prevented muscle degeneration in contralateral, non-injected muscles. Non-injected muscles of BTX-AþES group showed higher force with direct muscle compared to nerve stimulation, and retained glycogen following the depletion protocol, suggesting that BTX-A inhibited activation in non-target muscles. We conclude that ES exercise provides some protection from degeneration to target and non-target muscles during BTX-A treatments.

Keywords

Botulinum toxin, Botox, Muscle weakness, Muscle atrophy, Electrical stimulation, Skeletal muscle, Muscle spasticity, NZW rabbits

A型肉毒毒素(BTX-A)是治疗多种神经肌肉疾病的常用药物。它的作用是防止运动神经末梢释放乙酰胆碱，导致肌肉瘫痪。虽然被认为是安全的，但研究表明，BTX-A注射对靶肌肉和非靶肌肉都有不利影响。我们推测，通过直接电刺激(ES)锻炼肌肉可以减少这些不良影响。目的是确定ES运动对注射BTX-A肌肉的力量、质量和收缩物质的影响，并调查注射BTX-A是否影响非靶肌肉。新西兰大白兔17只，随机分为3组：(1)对照组注射生理盐水，(2)BTX-A组每月股四头肌注射BTX-A(3.5U/kg)，连续6个月；(3)BTX-A ES组每月注射BTX-A，每周3次，进行ES运动，共6个月。结果测量包括膝关节伸肌扭矩、肌肉质量和注射和未注射的对侧股四头肌的收缩物质面积百分比。糖原耗竭和直接肌肉刺激被用来评估未注射股四头肌可能的肌肉抑制。ES运动部分地防止了注射肌肉中的肌肉无力、萎缩和收缩物质的丢失，并且大部分地防止了对侧未注射肌肉中的肌肉退化。与神经刺激相比，BTX-A组未注射肌肉对直接肌肉的作用力更大，并按耗竭方案保留糖原，提示BTX-A抑制了非靶肌肉的激活。我们得出结论，在BTX-A治疗过程中，ES运动对靶肌肉和非靶肌肉的退化有一定的保护作用。

关键词

肉毒杆菌毒素、肉毒杆菌毒素、肌肉无力、肌肉萎缩、电刺激、骨骼肌、肌肉痉挛、新西兰兔