Anker Stefan D, Steinborn Wolfram, Strassburg Sabine
Department of Clinical Cardiology National Heart & Lung Institute, Imperial College London, UK.
Ann Med. 2004;36(7):518-29. doi: 10.1080/07853890410017467.
Chronic heart failure (CHF) remains an important and increasing public health care problem. It is a complex syndrome affecting many body systems. Body wasting (i.e., cardiac cachexia) has long been recognised as a serious complication of CHF. Cardiac cachexia is associated with poor prognosis, independently of functional disease severity, age, and measures of exercise capacity and cardiac function. Patients with cardiac cachexia suffer from a general loss of fat tissue, lean tissue, and bone tissue. 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 there is increasing evidence that metabolic, neurohormonal and immune abnormalities may play an important role. Cachectic CHF patients show raised plasma levels of epinephrine, norepinephrine, and cortisol, and they show high plasma renin activity and increased plasma aldosterone level. Several studies have also shown that cardiac cachexia is linked to raised plasma levels of tumour necrosis factor alpha and other inflammatory cytokines. 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）仍然是一个重要且日益严重的公共卫生保健问题。它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）长期以来一直被认为是CHF的一种严重并发症。心脏恶病质与预后不良相关，与功能疾病严重程度、年龄、运动能力和心脏功能指标无关。患有心脏恶病质的患者会出现脂肪组织、瘦组织和骨组织的普遍丧失。恶病质型CHF患者更虚弱且更早出现疲劳，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，但越来越多的证据表明，代谢、神经激素和免疫异常可能起重要作用。恶病质型CHF患者的血浆肾上腺素、去甲肾上腺素和皮质醇水平升高，且血浆肾素活性高，血浆醛固酮水平升高。多项研究还表明，心脏恶病质与血浆肿瘤坏死因子α和其他炎性细胞因子水平升高有关。身体消瘦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，预后不良。不同身体系统的复杂失衡可能导致身体消瘦的发生。
