静息能量消耗和慢性心力衰竭患者肌肉减少症的影响：来自研究共病加重心力衰竭（SICA-HF）的结果。
Resting energy expenditure and the effects of muscle wasting in patients with chronic heart failure: results from the Studies Investigating Comorbidities Aggravating Heart Failure (SICA-HF).
机构信息
Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
出版信息
J Am Med Dir Assoc. 2013 Nov;14(11):837-41. doi: 10.1016/j.jamda.2013.08.008. Epub 2013 Oct 2.
OBJECTIVES
Muscle wasting is common in patients with chronic heart failure (HF) and worsens functional status. Protein catabolism is characteristic of muscle wasting and contributes to resting energy expenditure (REE). Glucagonlike peptide 1 (GLP-1) is linked to REE in healthy individuals. We aimed to evaluate (1) whether REE is elevated in patients with HF with muscle wasting, and (2) whether basal GLP-1 levels are linked to REE in HF.
DESIGN
Cross-sectional study.
SETTING
Ambulatory patients with HF were recruited at the Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
PARTICIPANTS
A total of 166 patients with HF and 27 healthy controls participating in the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) were enrolled. GLP-1 was measured in 55 of these patients.
MEASUREMENTS
Body composition was measured by dual-energy X-ray absorptiometry (DEXA). Muscle wasting was defined as appendicular lean mass of at least 2 SDs below values of a healthy young reference group. REE was measured by indirect calorimetry. GLP-1 was assessed by ELISA.
RESULTS
Thirty-four of 166 patients (mean age 67.4 ± 10.2 years, 77.7% male, New York Heart Association class 2.3 ± 0.6) presented with muscle wasting. REE in controls and patients with muscle wasting was significantly lower than in patients without muscle wasting (1579 ± 289 and 1532 ± 265 vs 1748 ± 359 kcal/d, P = .018 and P = .001, respectively). REE normalized for fat-free mass (FFM) using the ratio method (REE/FFM) and analysis of covariance was not different (P = .23 and .71, respectively). GLP-1 did not significantly correlate with REE (P = .49), even not after controlling for FFM using multivariable regression (P = .15).
CONCLUSIONS
Differences in REE are attributable to lower FFM. GLP-1 does not relate to REE in patients with HF, possibly because of HF-related effects on REE.
目的
肌肉减少症在慢性心力衰竭（HF）患者中很常见，且会使患者的功能状态恶化。蛋白分解代谢是肌肉减少症的特征，会导致静息能量消耗（REE）增加。胰高血糖素样肽 1（GLP-1）与健康个体的 REE 有关。我们旨在评估（1）REE 是否在伴有肌肉减少症的 HF 患者中升高，以及（2）HF 患者的基础 GLP-1 水平是否与 REE 相关。
设计
横断面研究。
地点
德国柏林夏洛蒂医科大学维乔夫-克立克姆校区的门诊患者中招募 HF 患者。
参与者
共有 166 名 HF 患者和 27 名健康对照者参加了研究合并症加重心力衰竭（SICA-HF），其中 55 名患者接受了 GLP-1 检测。
测量方法
通过双能 X 射线吸收法（DEXA）测量身体成分。肌肉减少症定义为四肢瘦体重至少低于健康年轻参考组 2 个标准差。REE 通过间接量热法测量。GLP-1 通过 ELISA 评估。
结果
在 166 名患者中，有 34 名（平均年龄 67.4±10.2 岁，77.7%为男性，纽约心脏协会心功能分级 2.3±0.6）出现肌肉减少症。与无肌肉减少症的患者相比，对照组和有肌肉减少症的患者的 REE 明显较低（1579±289 和 1532±265 与 1748±359 kcal/d，P=0.018 和 P=0.001）。使用比率法（REE/FFM）对去脂体重（FFM）进行 REE 归一化，协方差分析无差异（P=0.23 和 P=0.71）。GLP-1 与 REE 无显著相关性（P=0.49），即使在使用多元回归控制 FFM 后也无相关性（P=0.15）。
结论
REE 的差异归因于较低的 FFM。GLP-1 与 HF 患者的 REE 无关，可能是由于 HF 对 REE 的影响。
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