慢性心力衰竭继发性肌少症:从现代医学和中医视角看整体的病理生理网络OA

Sarcopenia is a common and serious complication of chronic heart failure(CHF),with the two conditions forming a vicious cycle.However,the systemic pathological network underlying sarcopenia secondary to CHF remains unclear.This review constructed a multi-level mechanistic framework.Starting from the macroscopic hemodynamic disorders and neuroendocrine activation caused by CHF,the review proceeded to explain how they lead to mesoscopic multi-organ crosstalk dysfunction(including intestinal barrier damage/elevated trimethylamine N-oxide,impaired hepatic synthesis,pulmonary edema,and renal water-sodium retention).These alterations collectively created a systemic milieu characterized by chronic inflammation,oxidative stress,and insulin resistance.This milieu,in turn,triggered a series of microscopic lesions in skeletal muscle,encompassing metabolic imbalance of protein,neuromuscular junction degeneration,microcirculatory disturbances,and myokine secretion dysregulation,all of which ultimately converged,via mitochondrial dysfunction,on a common terminal pathway called"energy metabolism collapse."This review further interpreted this process through the lens of TCM theory,attributing it to a systemic dysfunction rooted in the progression from"Qi deficiency in heart"to"Yang deficiency in heart".This deficiency led to"Yang Qi counterflow"and"three energizer blockage",and the ensuing"internal toxin"and"sthenic fire",corresponding to the states of chronic inflammation and oxidative stress in modern medicine.The multi-level mechanistic framework proposed herein not only elucidates the active role of skeletal muscle via the"muscle-heart axis"but also thereby lays a theoretical foundation for future therapeutic strategies based on multi-target regulation and the integration of TCM and western medicine.