Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Berlin, Germany.
Curr Opin Support Palliat Care. 2014 Mar;8(1):15-24. doi: 10.1097/SPC.0000000000000030.
This article aims to describe molecular pathways involved in the development of muscle wasting and cachexia, diagnostic possibilities, and potential treatments that have seen clinical testing in recent heart failure trials. An understanding of the specific changes that cause an anabolic-catabolic imbalance is an essential first step in the development of pharmaceutical intervention strategies aimed at blocking muscle wasting.
Skeletal muscle mass and muscle strength are the most important determinants of exercise capacity in patients with heart failure. In contrast to cachexia, muscle wasting is not usually associated with weight loss, implying the need for sophisticated assessment methods to correctly diagnose muscle wasting, for example the use of computed tomography, magnetic resonance imaging, or dual energy X-ray absorptiometry. Simpler techniques such as handgrip strength, exercise testing, or even a biomarker may help in determining patients with a high pre-test probability of muscle wasting.
Despite intensive research efforts in the field of muscle wasting during the last couple of decades, no effective treatment of muscle wasting currently exists other than exercise training. This situation remains true even though study of the molecular pathways involved in muscle wasting suggests many therapeutic targets. Easily applicable diagnostic tools may help to identify patients at risk of developing muscle wasting.
本文旨在描述肌肉减少症和恶病质发生发展的分子途径、诊断可能性，以及在最近心力衰竭试验中进行临床测试的潜在治疗方法。了解导致合成代谢与分解代谢失衡的具体变化，是制定旨在阻止肌肉减少症的药物干预策略的重要第一步。
骨骼肌质量和肌肉力量是心力衰竭患者运动能力的最重要决定因素。与恶病质不同，肌肉减少症通常与体重减轻无关，这意味着需要使用复杂的评估方法来正确诊断肌肉减少症，例如使用计算机断层扫描、磁共振成像或双能 X 射线吸收法。更简单的技术，如握力、运动测试，甚至生物标志物，可能有助于确定肌肉减少症高预测试概率的患者。
尽管在过去几十年中，肌肉减少症领域进行了密集的研究，但除了运动训练外，目前还没有有效的肌肉减少症治疗方法。即使研究表明肌肉减少症涉及许多治疗靶点，但这种情况仍然如此。易于应用的诊断工具可能有助于识别有发生肌肉减少症风险的患者。
