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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.47 no.2 São Paulo June 1989

http://dx.doi.org/10.1590/S0004-282X1989000200003 

Estudo histoquímico do músculo esquelético no alcoolismo crônico

 

Muscle histochemistry in chronic alcoholism

 

 

M. L. FerrazI; A. A. GabbaiII; A. S. B. OliveiraIII; A. P. J. FerrariI; S. J. MiszputenIV; A. Ferreira NetoV; A. Castelo FilhoVI; B. SchmidtII

IDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Pós Graduando, DGC
IIDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Responsável pelo Setor de Patologia Neuromuscular, DN, EPM
IIIDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Pós Graduando, DN
IVDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM):Professor Adjunto da DGC
VDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Médico Residente, DN, EPM
VIDisciplina de Neurologia (DN) e na Disciplina de Gastroenterologia Clínica (DGC) da Escola Paulista de Medicina (EPM): Professor Adjunto e Chefe da Disciplina de Moléstias Infecciosas e Parasitárias, EPM

 

 


RESUMO

Vinte e dois pacientes alcoólatras crônicos foram submetidos a exame clínico neurológico e biópsia muscular. Eles apresentavam graus variáveis de fraqueza muscular proximal (cinturas escapular e pélvica), tendo um deles evoluído com quadro agudo de miopatia (avaliação pelo 'Manual Muscle Test', MMT). A principal alteração histológica observada é melhor evidenciada pela coloração da ATPase: atrofia muscular (95,3%), predominando nas fibras do tipo II A (71,4%) e, em 76% dos casos, alteração da imagem em mosaico à custa de agrupamentos de fibras musculares de mesmo tipo histoquímico ('type-grouping'). Secundariamente, em 63% dos casos, observa-se proliferação mitocondrial e conseqüente acúmulo lipídico intra-sarcoplasmático. No caso de instalação aguda da fraqueza muscular, o substrato anátomo-patológico é completamente diferente: presença de mlosite, predominantemente intersticial, caracterizada por infiltrado linfoplasmocitário e numerosas imagens de necrose tipo degeneração cérea de Zencker. Baseando-se em critérios histológicos, nossos dados sugerem que: a principal gênese da fraqueza muscular observada em pacientes alcoólatras crônicos tem natureza neurogênica (polineuropatia alcoólica); a atuação tóxica direta do etanol sobre o músculo esquelético está intimamente relacionada ao metabolismo mitocondrial; a chamada miopatia aguda alcoólica tenha etiologia inflamatória, do tipo viral.


SUMMARY

Twenty-two chronic acoholic patients were assessed by neurologic examination and muscle biopsy. The patients manifested proximal muscular weakness to a variable extent. One case presented as an acute bout of myopathy, according to the Manual Muscle Test, MMT. The most prominent histologic feature observed was muscle atrophy (95.3%) better evidenced through the ATPase stain with the predominance of type II A fibers (71.4%). Lack of the mosaic pattern (type grouping) seen in 76% of the cases and an important mitochondrial proliferation with intrasarcoplasmatic lipid accumulation in 63% of the patients. In case of acute presentation of muscle weakness the. pathological substrate is quite different, i.e. presence of myositis mainly interstitial characterized by lymphoplasmocytic infiltrate and several spots of necrosis like Zencker degeneration. Based on histologic criteria, our data suggest that: the main determinant of muscle weakness seen in chronic alcoholic patients is neurogenic in origin (alcoholic polineuropathy); the direct toxic action of ethanol under the skeletal muscle is closely related to the mitochondrial metabolism; the so-called acute alcoholic myopathy has probably viral etiology.


 

 

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Dr. Acary S. Bulle Oliveira - Setor de Patologia Neuromuscular, Disciplina de Neurologia, Escola Paulista de Medicina - Rua Botucatu 740 - 04023 São Paulo SP - Brasil.

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