The emerging role of the gut in chronic heart failure
The emerging role of the gut in chronic heart failure
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DOI：
10.1097/mco.0b013e32830a4c6e
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发表时间：
2008-09-01
影响因子：
3.1
通讯作者：
von Haehling, Stephan
中科院分区：
文献类型：
--
作者：
Sandek, Anja;Rauchhaus, Mathias;von Haehling, Stephan
综述目的慢性心力衰竭是一种多系统疾病，伴有交感神经张力增加、合成代谢/分解代谢失衡和慢性炎症。最近的研究表明，慢性心力衰竭患者消化道的形态、通透性和吸收发生改变。由于非闭塞性肠系膜缺血和肠道微循环紊乱，细菌内毒素被认为通过低灌注、水肿的肠壁进入血流，从而引发炎症反应。循环细胞因子作为心脏抑制剂。他们的血浆水平预测增加的死亡率在慢性heartfailure.Recent findingsThe本文章的重点是胃，小肠和大肠区域在慢性心力衰竭的具体改变。它描述了肠道屏障的渗漏和增加的细菌生物膜，这可能导致慢性炎症和营养不良。此外，我们审查方法肠灌注测量和潜在的therapeutic approaches.SummaryIt仍不清楚是否增加粘附细菌慢性心力衰竭患者是一个主要的或次要的事件，以及它们是否有助于全身炎症。慢性心力衰竭的临床症状可能会因黏膜完整性的缺失、局部和全身炎症以及转运蛋白的功能障碍而加重。因此，未来的研究需要解决肠屏障的病理生理学，其反应性似乎对心脏功能至关重要。
Purpose of reviewChronic heart failure is a multisystem disease with increased sympathetic tone, an anabolic/catabolic dysbalance, and chronic inflammation. Recent studies suggest an altered morphology, permeability, and absorption of the digestive tract in chronic heart failure. Due to nonocclusive mesenterial ischaemia and disturbed intestinal microcirculation, bacterial endotoxin is thought to enter the bloodstream through the hypoperfused, oedematous gut wall, thereby triggering an inflammatory response. Circulating cytokines act as cardiosuppressors. Their plasma levels predict increased mortality in chronic heart failure.Recent findingsThe present article focuses on specific alterations of the gastric, small intestinal, and large intestinal region in chronic heart failure. It describes the leaky intestinal barrier with an augmented bacterial biofilm that may contribute to chronic inflammation and malnutrition. Furthermore, we review methods for bowel perfusion measurement and potential therapeutic approaches.SummaryIt remains unclear whether increased adherent bacteria in patients with chronic heart failure are a primary or secondary event and whether they contribute to systemic inflammation. Both lack of mucosal integrity with consecutive local and systemic inflammation and dysfunction of transport proteins may worsen the clinical symptoms of chronic heart failure. Therefore, future studies need to address the pathophysiology of the intestinal barrier whose reactivity seems to be crucial for heart function.