中国中药杂志2026，Vol.51Issue(12)：3340-3351,12.DOI:10.19540/j.cnki.cjcmm.20260316.361
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
Overall pathophysiological network of sarcopenia secondary to chronic heart failure from perspectives of modern medicine and TCM
摘要
Abstract
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.关键词
慢性心力衰竭继发性肌少症/病理生理网络/肌-心轴/现代医学/中医Key words
sarcopenia secondary to chronic heart failure/pathophysiological network/muscle-heart axis/modern medicine/TCM引用本文复制引用
李璐,郑向炜..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[J].中国中药杂志,2026,51(12):3340-3351,12.基金项目
上海市卫健委综合医院中西协同引导项目(ZXXT-202302) （ZXXT-202302）
创新中药东盟中医药研究项目(DMZYYYJZX202406) （DMZYYYJZX202406）
刘毅中医药传承创新工作室项目(2025CXGZS-07) （2025CXGZS-07）
