Pugh Peter J, Jones Richard D, Jones T Hugh, Channer Kevin S
Department of Cardiology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
Eur J Heart Fail. 2002 Dec;4(6):673-80. doi: 10.1016/s1388-9842(02)00162-9.
Heart failure has traditionally been considered a disease of the myocardium, with symptoms arising from altered haemodynamics. However, it is now recognised that, in addition to marked neuroendocrine disturbance, there is perturbation of cytokine expression in patients with heart failure, resulting in an inflammatory imbalance. This not only influences symptoms, but also plays a central role in the underlying pathophysiological processes of heart failure, leading to disease progression and poorer prognosis. Recognition of the influence of cytokines, in particular tumour necrosis factor, has opened a new avenue for potential therapies for heart failure. Current approaches involve immunomodulation, aimed at suppressing tumour necrosis factor. We suggest that androgens may potentially offer a superior therapeutic strategy by their well-recognised non-specific immunosuppressive and anti-inflammatory effects. Studies of cell lines, human mononuclear cells and animals in vivo have demonstrated the 'anti-cytokine' actions of androgens, and we have found a similar action in whole blood from patients with heart failure. These effects, along with the anabolic action of these agents, make androgens an attractive potential option for treatment of patients with heart failure.
传统上，心力衰竭一直被视为一种心肌疾病，其症状源于血流动力学改变。然而，现在人们认识到，除了明显的神经内分泌紊乱外，心力衰竭患者还存在细胞因子表达紊乱，导致炎症失衡。这不仅影响症状，还在心力衰竭的潜在病理生理过程中起核心作用，导致疾病进展和预后较差。认识到细胞因子，特别是肿瘤坏死因子的影响，为心力衰竭的潜在治疗开辟了一条新途径。目前的方法包括免疫调节，旨在抑制肿瘤坏死因子。我们认为，雄激素因其公认的非特异性免疫抑制和抗炎作用，可能提供一种更好的治疗策略。对细胞系、人单核细胞和体内动物的研究已经证明了雄激素的“抗细胞因子”作用，并且我们在心力衰竭患者的全血中也发现了类似的作用。这些作用，连同这些药物的合成代谢作用，使雄激素成为治疗心力衰竭患者的一个有吸引力的潜在选择。
