Prevalence of cachexia in chronic heart failure and characteristics of body composition and metabolic status
Prevalence of cachexia in chronic heart failure and characteristics of body composition and metabolic status
复制标题
DOI：
10.1007/s12020-012-9836-3
复制
发表时间：
2013-06-01
期刊：
影响因子：
3.7
通讯作者：
Faber, Jens
中科院分区：
文献类型：
--
作者：
Christensen, Heidi Marie;Kistorp, Caroline;Faber, Jens
此前估计心脏恶病质的患病率为 8-42%。然而，慢性心力衰竭（CHF）的新治疗策略已经改善并降低了发病率和死亡率。因此，我们的目的是重新评估CHF门诊中恶病质的患病率，并在身体成分和相关生物标志物方面描述患有和不患有恶病质的CHF人群的特征。从 2008 年到 2011 年，我们对 238 名经过最佳治疗的非糖尿病 CHF 患者进行了心脏恶病质筛查，定义为 6 个月内无意的非水肿性体重减轻 > 5%。将患有恶病质 (n = 19) 和不患有恶病质 (n = 19) 的 CHF 患者 (LVEF < 45 %) 与既往有心肌梗死且左心室射血分数 (LVEF) > 45 % (n = 19) 的对照患者进行比较。这些组的年龄、性别和肾功能相匹配。通过双能X射线吸收测定法评估身体成分。恶病质的患病率为 10.5%。恶病质 CHF 中腹部脂肪 +/- A SD (%) 减少：27.4 +/- A 10.0 对比 37.5 +/- A 10.6 %（CHF，无恶病质）和 40.6 +/- A 8.0 %（对照），（P < 0.001）。在根据已知的 NT-proBNP 预测因子（LVEF 和 NYHA）进行调整的多元线性回归分析中，NT-proBNP 水平与腹部脂肪呈负相关； （β = -0.28；P = 0.018）。与对照组相比，恶病质 CHF 中的肌生长抑制素水平降低（P = 0.013）。根据最近的指南治疗，稳定型慢性心力衰竭患者恶病质的患病率低于之前的预期。恶病质的身体变化主要包括腹部脂肪量减少，其与 NT-proBNP 的负相关表明涉及腹部脂肪分解。我们的数据不支持循环肌生长抑制素作为肌肉萎缩的生物标志物的作用。
The prevalence of cardiac cachexia has previously been estimated to 8-42 %. However, novel treatment strategies for chronic heart failure (CHF) have improved and decreased morbidity and mortality. Therefore, we aimed to reassess the prevalence of cachexia in an outpatient CHF clinic and to characterize a CHF population with and without cachexia with respect to body composition and related biomarkers. From 2008 to 2011, we screened 238 optimally treated, non-diabetic CHF patients for cardiac cachexia, defined as unintentional non-oedematous weight loss of > 5 % over a parts per thousand yen6 months. CHF patients (LVEF < 45 %) with cachexia (n = 19) and without (n = 19) were compared to controls with prior myocardial infarction and left ventricular ejection fraction (LVEF) > 45 % (n = 19). The groups were matched for age, sex, and kidney function. Body composition was assessed by dual energy X-ray absorptiometry. The prevalence of cachexia was 10.5 %. Abdominal fat +/- A SD (%) was reduced in cachectic CHF: 27.4 +/- A 10.0 versus 37.5 +/- A 10.6 % (CHF, no cachexia) and 40.6 +/- A 8.0 % (controls), (P < 0.001). NT-proBNP levels were inversely correlated to abdominal fat in a multivariate linear regression analysis adjusted for known predictors of NT-proBNP (LVEF and NYHA); (beta = -0.28; P = 0.018). Myostatin levels were reduced in cachectic CHF compared to controls (P = 0.013). The prevalence of cachexia in stable CHF, treated according to recent guidelines, is lower than previously anticipated. Body alterations in cachexia consist mainly of reduced abdominal fat mass, and its inverse correlation to NT-proBNP suggests involvement of abdominal lipolysis. Our data do not support a role of circulating myostatin as a biomarker for muscle wasting.