慢性心力衰竭并发肌少症和心脏恶病质的诊治进展

Diagnosis and Treatment of Chronic Heart Failure Complicated with Sarcopenia and Cardiac Cachexia

肌少症和心脏恶病质是慢性心力衰竭常见的并发症。在慢性心力衰竭患者中,心输出量减少和全身充血状态会导致食物摄入量不足、运动能力下降、大量促炎因子释放、交感兴奋反射活动增强、机体免疫激活等一系列病理生理进程,从而导致骨骼肌减少及恶病质。目前的临床研究对治疗这两种综合征有潜在益处的药物包括睾酮、促生长激素释放多肽、重组人生长激素、必需氨基酸和β2受体激动剂等,另外运动锻炼及营养支持等辅助治疗措施亦被证实有效。现总结慢性心力衰竭患者肌肉减少的病理生理机制,并探讨治疗策略的新进展。

Sarcopenia and cardiac cachexia are common complications of chronic heart failure(CHF).In patients with CHF,reduced cardiac output and systemic congestion lead to a series of pathophysiological processes such as inadequate food intake,decreased exercise capacity,massive release of pro-inflammatory factors,increased sympathetic excitatory reflex activity,and immune activation of the organism,resulting in skeletal muscle reduction and cachexia.Currently,drugs with potential benefit in clinical studies for the treatment of muscle loss in both syndromes include testosterone,growth hormone-releasing polypeptide,recombinant human growth hormone,essential amino acids,andβ2-adrenergic receptor agonists,in addition to adjuvant therapeutic measures such as exercise and nutritional support,which have also been shown to be effective.This article summarizes the pathophysiological mechanisms of muscle loss in CHF patients and discuss new advances in treatment strategies.