Division of Pediatric Endocrinology, Department of Pediatrics, P.O. Box 800386, University of Virginia, Charlottesville, Virginia, USA.
Vitam Horm. 2013;92:197-242. doi: 10.1016/B978-0-12-410473-0.00008-8.
Cachexia is a condition typified by wasting of fat and LBM caused by anorexia and further endocrinological modulation of energy stores. Diseases known to cause cachectic symptoms include cancer, chronic kidney disease, and chronic heart failure; these conditions are associated with increased levels of proinflammatory cytokines and increased resting energy expenditure. Early studies have suggested the central melanocortin system as one of the main mediators of the symptoms of cachexia. Pharmacological and genetic antagonism of these pathways attenuates cachectic symptoms in laboratory models; effects have yet to be studied in humans. In addition, ghrelin, an endogenous orexigenic hormone with receptors on melanocortinergic neurons, has been shown to ameliorate symptoms of cachexia, at least in part, by an increase in appetite via melanocortin modulation, in addition to its anticatabolic and anti-inflammatory effects. These effects of ghrelin have been confirmed in multiple types of cachexia in both laboratory and human studies, suggesting a positive future for cachexia treatments.
恶病质是一种以厌食和进一步的内分泌调节能量储存为特征的脂肪和 LBM 消耗的病症。已知可引起恶病质症状的疾病包括癌症、慢性肾病和慢性心力衰竭；这些疾病与促炎细胞因子水平升高和静息能量消耗增加有关。早期研究表明，中枢黑皮质素系统是恶病质症状的主要介导者之一。这些途径的药理学和遗传拮抗作用可减轻实验室模型中的恶病质症状；但尚未在人类中进行研究。此外，内源性食欲刺激激素 ghrelin 及其在黑皮质素能神经元上的受体，已被证明可通过黑皮质素调节来增加食欲，从而至少部分缓解恶病质症状，除了其抗分解代谢和抗炎作用。在实验室和人体研究中，ghrelin 的这些作用已在多种类型的恶病质中得到证实，这表明恶病质治疗的前景乐观。
