von Haehling Stephan, Doehner Wolfram, Anker Stefan D
Department of Clinical Cardiology, Imperial College School of Medicine, National Heart and Lung Institute, Dovehouse Street, London, SW3 6LY, UK.
Cardiovasc Res. 2007 Jan 15;73(2):298-309. doi: 10.1016/j.cardiores.2006.08.018. Epub 2006 Sep 1.
Chronic heart failure is a complex catabolic state that carries a devastating prognosis. The transition from stable disease to cardiac cachexia is not well understood. Mechanisms that maintain the wasting process involve neurohormones and pro-inflammatory cytokines, which contribute to an imbalance in anabolic and catabolic pathways. A decrease in food intake alone rarely triggers the development of a wasting process, but dietary deficiencies in micronutrients and macronutrients contribute to the progression of the disease. Malabsorption from the gut as a result of bowel wall edema and decreased bowel perfusion also plays an important role. This article describes the complex interplay of hormonal systems in energy balance in patients with chronic heart failure as well as other factors such as malabsorption and dietary deficiencies that contribute to the wasting process. Finally, therapeutic approaches are discussed. These include dietary advice, ongoing studies, and future possibilities.
慢性心力衰竭是一种复杂的分解代谢状态，预后不良。从稳定疾病向心源性恶病质的转变尚不清楚。维持消瘦过程的机制涉及神经激素和促炎细胞因子，它们导致合成代谢和分解代谢途径失衡。仅食物摄入量减少很少引发消瘦过程的发展，但微量营养素和常量营养素的饮食缺乏会促进疾病进展。肠壁水肿和肠灌注减少导致的肠道吸收不良也起重要作用。本文描述了慢性心力衰竭患者能量平衡中激素系统的复杂相互作用，以及导致消瘦过程的其他因素，如吸收不良和饮食缺乏。最后，讨论了治疗方法。这些包括饮食建议、正在进行的研究和未来的可能性。
