Anker S D, Coats A J
Department of Cardiac Medicine, National Heart & Lung Institute, London, UK.
Chest. 1999 Mar;115(3):836-47. doi: 10.1378/chest.115.3.836.
Chronic heart failure (CHF) is a complex syndrome affecting many body systems. Body wasting (ie, cardiac cachexia) is a serious complication of CHF long known but little investigated. Although no specific diagnostic criteria have been established, we have suggested that cardiac cachexia be defined on the basis of the presence of documented nonintentional and nonedematous weight loss > 7.5% of the premorbid normal weight, occurring over a time period of > 6 months. Using this definition, 16% of an unselected CHF outpatient population was found to be cachectic. The cachectic state is predictive of impaired prognosis independently of age, functional disease classification, left ventricular ejection fraction, and peak oxygen consumption. The mortality in the cachectic cohort is 50% at 18 months. Analyzing body composition in detail, it has been found that patients with cardiac cachexia suffer from a general loss of fat tissue (ie, energy reserves), lean tissue (ie, skeletal muscle), and bone tissue (ie, osteoporosis). Cachectic CHF patients are weaker and fatigue earlier, which is due to both reduced skeletal muscle mass and impaired muscle quality. The pathophysiologic alterations leading to cardiac cachexia remain unclear, but initial cross-sectional studies have suggested that humoral neuroendocrine and immunologic abnormalities are linked, independently of established heart failure severity markers, to the presence of body wasting. Comparing the features of cachectic and noncachectic CHF patients with those of healthy control subjects, it is mainly the cachectic CHF patients who show raised plasma levels of epinephrine, norepinephrine, and cortisol; the highest plasma renin activity and aldosterone plasma concentrations; and the lowest plasma sodium level. Several studies have shown that cardiac cachexia is linked to raised plasma levels of tumor necrosis factor-ac. The degree of body wasting is strongly correlated with neurohormonal and immune abnormalities. The available evidence suggests that cardiac cachexia is a multifactorial neuroendocrine and metabolic disorder with a poor prognosis. A complex imbalance of different body systems may cause the development of body wasting.
慢性心力衰竭（CHF）是一种影响多个身体系统的复杂综合征。身体消瘦（即心脏恶病质）是CHF的一种严重并发症，早已为人所知，但研究较少。尽管尚未建立具体的诊断标准，但我们建议根据以下情况定义心脏恶病质：有记录表明非故意且非水肿性体重减轻超过病前正常体重的7.5%，且持续时间超过6个月。根据这一定义，在未经挑选的CHF门诊患者中，发现16%的患者患有恶病质。恶病质状态可独立于年龄、功能性疾病分类、左心室射血分数和峰值耗氧量预测预后受损。恶病质队列中18个月时的死亡率为50%。详细分析身体成分后发现，心脏恶病质患者存在脂肪组织（即能量储备）、瘦组织（即骨骼肌）和骨组织（即骨质疏松症）的普遍丢失。恶病质CHF患者更虚弱，疲劳出现得更早，这是由于骨骼肌质量减少和肌肉质量受损所致。导致心脏恶病质的病理生理改变尚不清楚，但初步的横断面研究表明，体液神经内分泌和免疫异常与身体消瘦的存在有关，且独立于已确定的心力衰竭严重程度标志物。将恶病质和非恶病质CHF患者的特征与健康对照者进行比较，主要是恶病质CHF患者的血浆肾上腺素、去甲肾上腺素和皮质醇水平升高；血浆肾素活性和醛固酮血浆浓度最高；血浆钠水平最低。多项研究表明，心脏恶病质与血浆肿瘤坏死因子-α水平升高有关。身体消瘦的程度与神经激素和免疫异常密切相关。现有证据表明，心脏恶病质是一种多因素神经内分泌和代谢紊乱，预后较差。不同身体系统的复杂失衡可能导致身体消瘦的发生。
