心力衰竭的营养不良与恶病质

　　心力衰竭是备受关注的公共健康问题。重度心力衰竭常与严重肌肉萎缩（术语称为心源性恶病质）相关。该过程通过全身炎性反应和肿瘤坏死因子引起，在某种程度上与癌症或人类免疫缺陷病毒感染等其他疾病相关的肌肉萎缩类似。不同程度的营养不良常常会因为营养摄入不足而加重。心源性恶病质严重降低了心衰患者的生活质量和生存率。加拿大西安大略大学、劳森实验医学健康研究所、多伦多大学、维克弗斯特医学院的综述概括了心衰营养状态的评估，探索了心源性恶病质的病理生理，并讨论了针对此类患者肌肉萎缩的治疗干预。

JPEN J Parenter Enteral Nutr. 2016;40(4):475-86.

Malnutrition and Cachexia in Heart Failure.

Rahman A, Jafry S, Jeejeebhoy K, Nagpal AD, Pisani B, Agarwala R

University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute Program of Experimental Medicine (POEM), London, Ontario, Canada; University of Toronto, Ancaster, Ontario, Canada; Wake Forest School of Medicine, Winston-Salem, North Carolina.

Heart failure is a growing public health concern. Advanced heart failure is frequently associated with severe muscle wasting, termed cardiac cachexia This process is driven by systemic inflammation and tumor necrosis factor in a manner common to other forms of disease-related wasting seen with cancer or human immunodeficiency virus. A variable degree of malnutrition is often superimposed from poor nutrient intake. Cardiac cachexia significantly decreases quality of life and survival in patients with heart failure. This review outlines the evaluation of nutrition status in heart failure, explores the pathophysiology of cardiac cachexia, and discusses therapeutic interventions targeting wasting in these patients.

PMID: 25634161

DOI: 10.1177/0148607114566854