Anker S D, Al-Nasser F O
Franz-Volhard-Klinik (Charité Campus Berlin-Buch), Max-Delbrück Centrum, Berlin, Germany.
Heart Fail Monit. 2000;1(2):42-9.
Congestive chronic heart failure (CHF) is a progressive disorder in which a complex interaction of haemodynamic, neurohormonal and metabolic disturbances leads to subsequent immune activation. The greatest attention has been given to the concept that the progression of heart failure is due to neurohormonal abnormalities and this has led to substantial therapeutic benefits for CHF. The aim of this review is to describe a number of the interactions between neurohormonal pathways and metabolic problems relevant in CHF. Besides the renin-angiotensin-aldosterone-system, steroid and thyroid hormones, growth factors, insulin and inflammatory cytokines (e.g. tumour necrosis factor-alpha [TNF-alpha]) are considered. TNF-alpha is potentially a key molecule with enormous interactive opportunities within a regulatory network of energy metabolism, immune function and neuroendocrine and hormonal function. The most dramatic metabolic problem in heart failure patients is the development of cardiac cachexia. Currently, no specific therapy exists and the prognosis is poor. There are promising approaches (counteracting TNF-alpha or applying anabolic growth factors) but these are not without risk and are expensive, and their application may, therefore, be limited to certain subgroups of patients. In the future, it will not be enough to monitor cardiac function and symptomatic status in heart failure patients. Rather, the patients' metabolic status may need to be taken, as well as an assessment of peak oxygen consumption, body composition and hormonal status.
充血性慢性心力衰竭（CHF）是一种进行性疾病，其中血流动力学、神经激素和代谢紊乱的复杂相互作用导致随后的免疫激活。心力衰竭进展归因于神经激素异常这一概念受到了极大关注，并且这已为CHF带来了实质性的治疗益处。本综述的目的是描述一些与CHF相关的神经激素途径和代谢问题之间的相互作用。除了肾素 - 血管紧张素 - 醛固酮系统外，还考虑了类固醇和甲状腺激素、生长因子、胰岛素和炎性细胞因子（如肿瘤坏死因子 -α [TNF-α]）。TNF-α可能是一个关键分子，在能量代谢、免疫功能以及神经内分泌和激素功能的调节网络中具有巨大的相互作用机会。心力衰竭患者最严重的代谢问题是心源性恶病质的发展。目前，尚无特异性治疗方法，且预后较差。有一些有前景的方法（中和TNF-α或应用合成代谢生长因子），但这些方法并非没有风险且费用昂贵，因此其应用可能仅限于某些患者亚组。未来，仅监测心力衰竭患者的心脏功能和症状状态是不够的。相反，可能需要考虑患者的代谢状态，以及对峰值耗氧量、身体成分和激素状态进行评估。
