Azhar Gohar, Wei Jeanne Y
Geriatric Research Education and Clinical Center (GRECC), Central Arkansas Veterans Healthcare System (CAVHS), Arkansas, USA.
Curr Opin Clin Nutr Metab Care. 2006 Jan;9(1):18-23. doi: 10.1097/01.mco.0000198060.10991.50.
Congestive heart failure is a leading cause of morbidity and mortality, especially in older persons. In advanced stages of the disease, congestive heart failure can be associated with serious complications such as cardiac cachexia (defined here as weight loss of more than 6% in 6 months). This review will discuss recent insights into the pathophysiology, anthropometric predictors and potential management of cardiac cachexia.
Cardiac cachexia and the associated progressive weight loss are sometimes overlooked by care providers. A delay in diagnosis often results in further loss of vital tissues, progressive weakness, fall-related injuries and potentially long-term care institutionalization and/or death. Emerging data suggest that congestive heart failure is a dynamic disorder of many organ systems, including the myocardial, neurohormonal, immune, vascular, gastrointestinal, renal and musculoskeletal systems. It is becoming more widely appreciated that it is the deterioration of this interactive multisystem complex that results in the systemic inflammation and progressive wasting and atrophy of muscle and other organ tissues, which is the hallmark of cardiac cachexia.
Cardiac cachexia in congestive heart failure patients may be associated with a low level of physical activity. A high systemic inflammatory state is another marker of cardiac cachexia. Prudent anti-inflammatory nutrition, dietary supplements and exercise can serve to ameliorate and/or potentially prevent progressive wasting. A better understanding of factors contributing to the development of cardiac cachexia will enable us to design preventive strategies and provide improved care for individuals with this debilitating condition.
充血性心力衰竭是发病和死亡的主要原因，在老年人中尤为如此。在疾病的晚期，充血性心力衰竭可能与严重并发症相关，如心源性恶病质（此处定义为6个月内体重减轻超过6%）。本综述将讨论近期关于心源性恶病质的病理生理学、人体测量学预测指标及潜在治疗方法的见解。
心源性恶病质及相关的渐进性体重减轻有时会被医护人员忽视。诊断延迟往往会导致重要组织进一步丧失、渐进性虚弱、跌倒相关损伤，以及可能的长期护理机构安置和/或死亡。新出现的数据表明，充血性心力衰竭是一种涉及多个器官系统的动态疾病，包括心肌、神经激素、免疫、血管、胃肠道、肾脏和肌肉骨骼系统。人们越来越普遍认识到，正是这种相互作用的多系统复合体的恶化导致了全身炎症以及肌肉和其他器官组织的渐进性消瘦和萎缩，这是心源性恶病质的标志。
充血性心力衰竭患者的心源性恶病质可能与低水平的身体活动有关。高全身炎症状态是心源性恶病质的另一个标志。谨慎的抗炎营养、膳食补充剂和运动有助于改善和/或潜在预防渐进性消瘦。更好地了解导致心源性恶病质发生的因素将使我们能够设计预防策略，并为患有这种衰弱病症的个体提供更好的护理。
