加压素在血压调节中的作用

生理范围内的血浆加压素,具有强烈的缩血管作用;但在正常动物,引起血压升高所需的加压素血浆浓度,远远超过最大抗利尿作用所需的浓度。脱水、失血时,加压素对维持动脉血压起重要作用;加压素亦与肾素血管紧张素有互补关系。     

高钾饮食调节血压的肾脏机制

高血压是引起心血管疾病、脑卒中和肾功能衰竭最强风险因素之一。日常生活方式和饮食是调节血压的重要因素。高血压患者可通过增加体育锻炼、减少酒和钠的摄取以及戒烟等方式降低血压。除此之外,饮食中增加钾含量丰富的食物也有益于血压的控制。慢性肾脏疾病患者通常伴有高血压,说明肾脏是维持血压平衡的重要器官。在肾脏,高钾饮食降低血压的效应与肾小管对Na Cl的重吸收降低、尿钠排泄增加有关。在这个过程中,肾脏远端小管(distal convoluted tubule,DCT)细胞膜上的钠-氯同向转运体(sodium-chloride cotransporter,NCC)发挥至关重要作用。在DCT细胞,NCC的激活与对细胞内Cl~-敏感的丝氨酸/苏氨酸蛋白激酶(with-no-lysine kinases,WNKs)及下游Ste20相关的富含脯氨酸-丙氨酸激酶(Ste20-related proline-alanine-rich kinase,SPAK)和氧化应激反应激酶1 (oxidative stress-responsive kinase 1,OSR1)相关,其中WNK4是WNKs家族决定NCC活性的...     

Dahl盐敏感大鼠高血压形成的肾脏代谢机制

肾脏调控着机体的水盐代谢、血容量和血管阻力,是参与血压调节的主要靶器官.高盐饮食会诱发盐敏感个体水钠潴留以及持续性的内皮功能障碍,并促成血压升高.Dahl盐敏感(Dahl salt sensitive,Dahl-SS)大鼠作为研究盐敏感高血压的经典动物模型,具备血压的盐敏感性、高脂血症、胰岛素抵抗、肾功能衰竭、尿蛋白分...     

电刺激肾神经传入纤维对肾水钠钾排出的影响

本文探讨肾神经传入纤维对肾排泄功能的影响及其机制。在戊巴比妥钠麻醉猫中,切除双侧颈动脉窦神经、主动脉神经和迷走神经(SAD+VD),电刺激肾神经传入纤维使动脉血压明显升高,去神经肾的尿量,排钠量显著增多,排钾量和肾小球滤过率不变。神经完好肾的排钠量显著增加,尿量、排钾量和肾小球滤过率均无显著变化。在刺激肾神经传入纤维时,将动脉血压控制在对照期血压水平,两侧肾的尿量、排钠量、排钾量显著减少;神经完好肾的肾小球滤过率减少,而去神经肾的肾小球滤过率无显著改变。脊髓横断不能消除神经完好肾上述肾排泄功能的改变,但可消除去神经肾排泄功能的改变。这些结果表明,在SAD+VD猫中,控制动脉血压不变时,刺激肾神经传入纤维可使有神经肾和去神经肾排尿、排钠和排钾减少。在神经完好肾中这些反应可在脊髓水平完成。     

生物钟基因与肾脏功能和疾病

哺乳动物昼夜节律的产生与生物钟基因的周期性表达密切相关。Bmal1、Clock、Per和Cry是研究最为广泛的核心生物钟基因。肾脏在维持机体体液平衡和血压稳态方面发挥重要作用,其多数生理功能均呈现出一定的昼夜节律性,如动脉血压的调节、肾血流量的维持、肾小球滤过率的调控,以及水的重吸收和钠的排泄等都会随昼夜变化而产生节律性振荡。研究表明,核心生物钟基因的变异与许多肾脏疾病的发生发展密切相关。因此,深入了解核心生物钟基因在肾脏功能和疾病中的作用对防治肾脏疾病具有重要意义。     

人的血压及其调节

血压血压是血液在血管中流动时所产生的压迫管壁的压力。一般以毫米汞柱来计算。管壁薄的血管中的血液压力可因管外的压力作用而被抵销。在肺脏较高部位的毛细血管,由于血管外的压力可以超过管内的血液压力,管壁可被压陷,血流阻断。与此不同,管壁厚的动脉,不会发生这种情况。从动脉到小动脉、毛细血管,再从外周静脉     

兔肾性高血压时的动脉压力感受器反射

14只雄性家兔在双肾缩扎术后12周,经氨基甲酸乙酯静脉麻醉,分别在缓冲神经完整、切断两侧减压神经或切断两侧窦神经后静注新福林或硝普钠升降血压以改变动脉压力感受器活动,观察其心率、后肢血管阻力和肾交感神经活动的反射性变化,并与正常血压兔的反射效应相比较。主要结果如下:(1) 动物双肾动脉缩扎后12周,平均动脉血压(131±9mmHg)较正常动物血压(95±10mmHg)有显著升高(P<0.001);(2) 缓冲神经完整时,新福林和硝普钠升降血压诱发的心率反射性变化与正常血压动物相比显著减弱(P<0.001),而后肢血管阻力和肾交感神经活动的反射性调节无明显改变,表明肾性高血压动物的心率反射性调节与外周循环的反射性调节机能不相平行;而由股动脉内直接注射新福林或硝普钠时,股动脉灌流压的增减幅度与正常血压动物相比并无明显差异;(3) 切断两侧减压神经或切断两侧窦神经后,在正常动物仅使反射性心率调节作用减弱,而后肢血管阻力和肾交感神经活动的反射性调节无明显改变;但在高血压动物,除心率的反射性调节进一步减弱外,新福林和硝普钠升降血压时后肢血管阻力和肾交感神经活动的反射性调节效应也显著地减弱(P<0.001),提示肾性高血压时动脉压力感受器反射的潜在调节能力降低。由此似表明,肾性高血压时动脉压力感受器反射     

慢性动脉血压调节与原发性高血压病——Ⅱ.原发性高血压病

原发性高血压病的发生原因和发病机理十分复杂,很多问题目前并不十分清楚。通过近几十年的研究,大家比较一致的看法是,原发性高血压病的内因是肾脏功能的损伤,其发生条件（外因）是摄取的食盐（钠）过多。人类饮食中添加食盐已有几千年的历史,它是人类文明发展的一种表现。然而各种研究的结果表明,食盐的过量摄取的确是高血压的元凶。此外,原发性高血压多见于老年人。由于有这些特点,因此原发性高血压病常常被看成是一种“文明”病,一种肾脏的疾病,一种老年人常见的病。本文将对这些特点作进一步的分析和讨论。     

体液调节研究的新进展

本文介绍了渗透压调节与容积调节在维持体液平衡中的作用及其相互关系。重点讨论了脑室内钠—敏感感受器的性质、部位及在体内钠与水平衡的调节中的重要作用。调节饮水与ADH分泌的钠感受器局限于第三脑室的前壁,而调节肾排钠量的钠感受器沿脑室系统作较广泛的分布,向后直延伸到第四脑室。最后介绍了脑内肾素—血管紧张素系统,并讨论了AⅡ在钠与水平衡中的作用,其作用机理可能是加速钠感受器膜上Na~ 的转运,从而使钠感受器容易兴奋。     

癫痫电网络重建过程中的海马-体循环动脉血压调节网络

目的:观察右侧海马(HPC)微量注射印防己毒素(PTX)诱导HPC癫痫电网络重建过程中HPG体循环动脉血压调节网络的形成.方法:将PTX(7.2μg)微量注射到大鼠右侧HPC诱发HPC癫痫,四通道同步记录左侧深部电图、单个HPC细胞外单位放电、左侧股动脉血压和标准Ⅱ导联心电图.结果:将PTX微量注射到右侧HPC后可以引起以下效应:①对侧HPC神经元长时程爆发式单位放电与单位后放电,并具有相似的脉冲间隔(interspike intervals,ISI)点分布;②延迟对侧HPC神经元爆发式单位放电与相对应的股动脉血压下降发生的时间关系;③出现复合式的对侧HPC神经元爆发式单位放电或单位后放电和股动脉血压下降耦合;④具有相似点分布特征的对侧HPC网络波峰间隔(interpeak intervals,IPI)和单个神经元ISI共同参与了HPC-体循环动脉血压调节网络的构成.结论:将PTX微量注射到右侧HPC可以在诱导对侧HPC癫痫网络形成的同时通过特征性的瞬时编码形式调制HPC-体循环动脉血压调节网络的功能活动.     

Role of zinc in regulation of arterial blood pressure and in the etiopathogenesis of arterial hypertension

Increased gastrointestinal absorption and urinary excretion of zinc has been confirmed in experimental and clinical studies on primary arterial hypertension as a result from changes of intracellular and extracellular zinc content. In arterial hypertension, the levels of zinc in serum, lymphocyte, and bone decrease while increasing in heart, erythrocytes, kidney, liver, suprarenal glands and spleen. These changes result in the loss of zinc homeostasis that leads to various degrees of deficiency, not entirely compensated by nutritional factors or increased absorption in the gastrointestinal tract. Loss of zinc homeostasis can be both cause and effect of high blood pressure. In the present review, the role of zinc metabolism changes and its mechanisms in arterial hypertension are discussed.     

Regulation of arterial pressure: role of pressure natriuresis and diuresis

The importance of the renal pressure natriuresis and diuresis mechanisms in long-term control of body fluid volumes and arterial pressure has been controversial and difficult to quantitate experimentally. Recent studies, however, have demonstrated that in several forms of chronic hypertension caused by aldosterone, angiotensin II (AngII), vasopressin, or norepinephrine and adrenocorticotropin, increased renal arterial pressure is essential for maintaining normal excretion of sodium and water in the face of reduced renal excretory capability. When renal arterial pressure was servo-controlled in these models of hypertension, sodium and water retention continued unabated, causing ascites, pulmonary edema, or even complete circulatory collapse within a few days. Apparently, other mechanisms for volume homeostasis, such as the various natriuretic and diuretic factors that have been postulated, are not sufficiently powerful to maintain fluid balance in the absence of increased renal arterial pressure when renal excretory function is reduced in these forms of hypertension. The intrarenal mechanisms responsible for pressure natriuresis and diuresis are not entirely clear, but they seem to involve small increases in glomerular filtration rate and filtered load as well as reductions in fractional reabsorption in proximal and distal tubules. During chronic disturbances of arterial pressure additional factors, especially changes in AngII and aldosterone formation, act to amplify the effectiveness of the basic renal pressure natriuresis and diuresis mechanisms in regulating arterial pressure and body fluid volumes.     

Fluid input control in burned patients with the aid of ultrasonic arterial blood pressure monitoring.

Arterial blood pressure is nowadays easily and reliably measured with ultrasonic equipment. It correlates well with blood volume, and may therefore be used to guide fluid infusion in burned patients. Monitoring of blood pressure, instead of application of old-fashioned recipes, helps to avoid dangerous situations of hypovolemia or overload.     

Non-invasive quantification of peripheral arterial volume distensibility and its non-linear relationship with arterial pressure

Arterial wall function is associated with different physiological and clinical factors. Changes in arterial pressure cause major changes in the arterial wall. This study presents a simple non-invasive method to quantify arterial volume distensibility changes with different arterial pressures.The electrocardiogram, finger and ear photoplethysmogram were recorded from 15 subjects with the right arm at five different positions (90°, 45°, 0°, ?45° and ?90° referred to the horizontal level). Arm pulse propagation time was determined by subtracting ear pulse transit time from finger pulse transit time, and was used to obtain arterial volume distensibility. The mean arterial blood pressure with the arm at the horizontal level was acquired, and changes with position were calculated using the hydrostatic principle that blood pressure in the arm is linearly related to its vertical distance from the horizontal level.The mean arm pulse propagation times for the five different positions were 88, 72, 57, 54 and 52 ms, with the corresponding mean arterial volume distensibility of 0.234%, 0.158%, 0.099%, 0.088% and 0.083% per mmHg. For all consecutive changes in arm position, arm pulse propagation time and arterial volume distensibility, were significantly different (all probability P<0.05). The slopes of arm pulse propagation time and arterial volume distensibility against arterial pressure decreased significantly between each consecutive arm position from 90° to ?45° (all P<0.01), indicating significant non-linearity.The experimental results fitted the physiological exponential model and Langewouters’ arctangent model well, and were also comparable to published data with arterial volume distensibility approximately tripling for transmural pressure changes from 101 to 58 mmHg.In conclusion, the inverse and non-linear relationship between arterial volume distensibility and arterial pressure has been quantified using a simple arm positioning procedure, with the greatest effect at low pressures. This work is an important step in developing a simple non-invasive technique for assessing peripheral arterial volume distensibility.     

Venous cuff pressures from 30 mmHg to diastolic pressure are recommended to measure arterial inflow by plethysmography.

Venous occlusion strain gauge plethysmography (VOP) is based on the assumption that the veins are occluded and arterial inflow is undisturbed by the venous cuff pressure. Literature is not clear concerning the pressure that should be used. The purpose of this study was to determine the optimal venous occlusion pressure at which the highest arterial inflow is achieved in the forearm, calf, and leg by using VOP. We hypothesized that, for each limb segment, an optimal (range of) venous cuff pressure can be determined. Arterial inflow in each limb segment was measured in nine healthy individuals by VOP by using pressures ranging from 10 mmHg up to diastolic blood pressure. Arterial inflows were similar at cuff pressures between 30 and 60 mmHg for the forearm, leg, and calf. Arterial inflow in the forearm was significantly lower at 10 mmHg compared with the other cuff pressures. In addition, arterial inflows at 20 mmHg tended to be lower in each limb segment than flow at higher cuff pressures. In conclusion, no single optimum venous cuff pressure, at which a highest arterial inflow is achieved, exists, but rather a range of optimum cuff pressures leading to a similar arterial inflow. Venous cuff pressures ranging from 30 mmHg up to diastolic blood pressure are recommended to measure arterial inflow by VOP.     

Mechanical programming of arterial smooth muscle cells in health and ageing

Arterial smooth muscle cells (ASMCs), the predominant cell type within the arterial wall, detect and respond to external mechanical forces. These forces can be derived from blood flow (i.e. pressure and stretch) or from the supporting extracellular matrix (i.e. stiffness and topography). The healthy arterial wall is elastic, allowing the artery to change shape in response to changes in blood pressure, a property known as arterial compliance. As we age, the mechanical forces applied to ASMCs change; blood pressure and arterial wall rigidity increase and result in a reduction in arterial compliance. These changes in mechanical environment enhance ASMC contractility and promote disease-associated changes in ASMC phenotype. For mechanical stimuli to programme ASMCs, forces must influence the cell’s load-bearing apparatus, the cytoskeleton. Comprised of an interconnected network of actin filaments, microtubules and intermediate filaments, each cytoskeletal component has distinct mechanical properties that enable ASMCs to respond to changes within the mechanical environment whilst maintaining cell integrity. In this review, we discuss how mechanically driven cytoskeletal reorganisation programmes ASMC function and phenotypic switching.     

Effects of changes in circulating volume and in arterial pressure on plasma renin activity in the intact rat

The effects of changes in arterial pressure and in circulating volume on Plasma Renin Activity (PRA) in the intact rat were compared by two experimental procedures. Gradual volume depletion was induced by intraperitoneal injection of a hyperoncotic polyethyleneglycol solution (PEG) in absence of acute changes in Systolic Arterial Pressure (SAP). SAP was measured in the conscious state by the tail cuff technique. Plasma Protein Concentration (PPC) and Hematocrit (Hct) increases after PEG injection were compared as the index for measuring the Plasma Volume Reduction (PVR). PRA showed a significant (p less than 0.001) linear relationship with PPC, suggesting a direct dependence of renin secretion on volume depletion. Acute changes in the circulating volume were induced by controlled hemorrhages of 5.0, 10.0, 15.0 and 20.0 ml of blood/kg body weight. The increase in PRA showed a significant relationship with the changes in circulating volume, but it did not show any dependence on the changes in Mean Arterial Pressure (MAP). Our results suggest that, in the intact and conscious rat, renin secretion responds to the information from the cardiopulmonary volume receptors rather than to that from the high pressure receptors.     

Mechanisms of pressure-diuresis and pressure-natriuresis in Dahl salt-resistant and Dahl salt-sensitive rats

ABSTRACT: BACKGROUND: Data on blood flow regulation, renal filtration, and urine output in salt-sensitive Dahl S rats fed on high-salt (hypertensive) and low-salt (prehypertensive) diets and salt-resistant Dahl R rats fed on high-salt diets were analyzed using a mathematical model of renal blood flow regulation, glomerular filtration, and solute transport in a nephron. RESULTS: The mechanism of pressure-diuresis and pressure-natriuresis that emerges from simulation of the integrated systems is that relatively small increases in glomerular filtration that follow from increases in renal arterial pressure cause relatively large increases in urine and sodium output. Furthermore, analysis reveals the minimal differences between the experimental cases necessary to explain the observed data. It is determined that differences in renal afferent and efferent arterial resistance are able to explain all of the qualitative differences in observed flows, filtration rates, and glomerular pressure as well as the differences in the pressure-natriuresis and pressure-diuresis relationships in the three groups. The model is able to satisfactorily explain data from all three groups without varying parameters associated with glomerular filtration or solute transport in the nephron component of the model. CONCLUSIONS: Thus the differences between the experimental groups are explained solely in terms of difference in blood flow regulation. This finding is consistent with the hypothesis that, if a shift in the pressure-natriuresis relationship is the primary cause of elevated arterial pressure in the Dahl S rat, then alternation in how renal afferent and efferent arterial resistances are regulated represents the primary cause of chronic hypertension in the Dahl S rat.     

Raised arterial pressure in parents of proteinuric insulin dependent diabetics.

Arterial pressure is raised early in the subset of insulin dependent diabetics at risk of later development of progressive renal failure, suggesting that liability to arterial hypertension may play a part in the aetiology of diabetic kidney disease. Evidence for a genetic basis was therefore sought by measuring the blood pressures of the 26 surviving parents of 17 insulin dependent diabetic patients with proteinuria and comparing them with those of the parents of 17 matched insulin dependent diabetic patients without proteinuria selected from the same cohort. Systolic and diastolic pressures were significantly higher in parents of the proteinuric (mean (SD) 161 (27)/94 (14) mm Hg) than in parents of the non-proteinuric patients (146 (21)/86 (11) mm Hg). The difference between the sample mean blood pressures was 15 mm Hg (95% confidence interval 3.3 to 26.7 mm Hg) for systolic pressure and 8 mm Hg (95% confidence interval 0.8 to 15.2 mm Hg) for diastolic pressure. These differences were independent of age, sex, and adiposity. There was a significant correlation between the mean arterial pressures in the proteinuric patients and the higher mean blood pressure in their parents. High blood pressure in non-diabetic parents may be a marker of susceptibility to clinical nephropathy in their insulin dependent diabetic offspring.