Pathophysiology of peripheral muscle wasting in cardiac cachexia
Pathophysiology of peripheral muscle wasting in cardiac cachexia
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DOI：
10.1097/01.mco.0000165002.08955.5b
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发表时间：
2005-05-01
影响因子：
3.1
通讯作者：
Kremastinos, DT
中科院分区：
文献类型：
--
作者：
Filippatos, GS;Anker, SD;Kremastinos, DT
许多不同的机制被提出来解释心力衰竭患者的肌肉萎缩；然而，发病机制在很大程度上仍不清楚。这篇论文着眼于目前关于心脏恶病质中骨骼肌萎缩的病理生理学进展。许多研究表明，营养不良、吸收不良、代谢功能障碍、合成代谢/分解代谢失衡、炎症和神经激素激活以及细胞死亡在心脏恶病质中消耗的发病机制中起重要作用。然而，肌肉变化的病因尚不完全清楚，在患有心脏恶病质的动物的骨骼肌活检中，观察到蛋白质降解率增加，泛素-蛋白酶体蛋白水解途径的活性增加。骨骼肌细胞凋亡也可能在肌肉萎缩和萎缩中发挥作用，并且可以通过神经激素抑制部分预防，但最近有报道称，在慢性心力衰竭的病毒质患者中，细胞凋亡并不是细胞死亡和肌肉损失的主要途径。许多假说被用来解释心肌恶病质中肌肉萎缩的发病机制。心脏恶病质是一种多因素疾病，针对不同的途径将是有效治疗的必要条件。慢性心力衰竭中存在的免疫和神经激素异常可能在耗竭过程的发病机制中起重要作用。有人认为，在不同的病毒质状态下，共同的发病机制导致了肌肉质量的损失。心脏恶病质和其他恶病质状态是否存在共同的通路，还需要更多的研究来证明。
Purpose of review Many different mechanisms have been proposed to explain muscle wasting in patients with heart failure; however, the pathogenesis remains largely obscure. This manuscript looks at current developments concerning the pathophysiology of skeletal muscle wasting in cardiac cachexia.Recent findings Many studies have shown that malnutrition, malabsorption, metabolic dysfunction, anabolic/catabolic imbalance, inflammatory and neurchormonal activation, and cell death play an important role in the pathogenesis of wasting in cardiac cachexia. However, the aetiology of the muscle changes is not entirely clear, In biopsies of skeletal muscles from animals with cardiac cachexia increased rates of protein degradation have been observed, with increased activity of the ubiquitin-proteasome proteolytic pathway. Skeletal muscle apoptosis may also play a role in muscle atrophy and wasting and can be partly prevented by neurohormonal inhibition, but it has recently been reported that in cachectic patients with chronic heart failure apoptosis is not the main pathway of cell death and muscle loss.Summary Many hypotheses have been used to explain the pathogenesis of muscle wasting in cardiac cachexia. Cardiac cachexia is a multifactorial disorder, and the targeting of different pathways will be necessary for effective treatment. The immune and neurohormonal abnormalities present in chronic heart failure may play a significant role in the pathogenesis of the wasting process. It has been suggested that common pathogenetic mechanisms underlie the loss of muscle mass in different cachectic states. More studies are needed to show whether there is a common pathway in cardiac cachexia and the other cachectic states.