动脉压力感受器反射与高血压

关于颈动脉窦和主动脉弓压力感受器反射与高血压关系的研究,近年来已取得了不少进展。本文着重介绍动脉压力感受器反射在血压调控中的作用,分析高血压状态下该反射的机能特征及可能发生变化的各个环节。     

内皮素对麻醉大鼠动脉压力感受器反射的调制作用

在27只隔离灌流颈动脉窦区的麻醉大鼠,观察了内皮素（ET-1）对动脉压力感受器反射的调制作用。结果如下：（1）在颈动脉窦区灌流1nmol／L的ET-1时,压力感受器机能曲线向左下方移位,曲线的最大斜率（PS）由0.40±0.02增至0.51±0.02kPa／kPa（P＜0.01）,压力感受器反射性血压下降幅度（RD）由5.66±0.23增至6.76±0.22kPa（P＜0.01）。由此提示,这一剂量的FT-1对压力感受器反射有易化作用。（2）用10nmol／L的ET-1灌流时,压力感受器机能曲线则向右上方移位,PS降至0.28±0.01kPa／kPa（P＜0.01）,RD降至4．16±0.19kPa（P＜0.01）;100nmol／L的ET-1可使压力感受器机能曲线向右上方移位更为明显,PS降至0.19±0.03kPa（P＜0.001）,RD进一步降至3.33±0.38kPa（P＜0.001）。这些结果表明,上述两种剂量的ET-1对压力感受器反射有抑制作用。（3）ETA受体选择性阻断剂BQ123（0.15μmol／L）可以阻断ET-1（10nmol／L）对压力感受器反射的抑制效应。（4）预先灌流KATP通道阻断剂格列苯脲（10μmol／L）,也可阻断ET-1的效应。综上所述,ET-1对压力感受器反射有双重效应,低剂量时有易化作用,而较高剂量时则有抑制作用,后一作用由ET-1型受体介导并有KATP通道的参与。     

17β-雌二醇抑制雄性大鼠颈动脉窦压力感受器反射

采用隔离灌流麻醉雄性大鼠颈动脉窦技术 ,观察了 17β 雌二醇 (E2 )对颈动脉窦压力感受器反射的影响。结果如下 :(1)以E2 (10 μmol/L)隔离灌流颈动脉窦区时 ,压力感受器机能曲线向右上方移位 ,曲线最大斜率(peakslope,PS)由 0 49± 0 0 3降至 0 2 5± 0 0 1(P <0 0 1) ,反射性血压下降幅度 (reflexdecrease,RD)由 7 37± 0 42kPa降至 3 49± 0 2 0kPa (P <0 0 0 1) ,阈压 (thresholdpressure ,TP)和饱和压 (saturationpressure ,SP)分别由 9 5 2±0 6 8kPa和 2 4 5 3± 0 48kPa增至 13 3± 0 11kPa (P <0 0 0 1)和 2 7 5 2± 0 2 0kPa (P <0 0 1) ,其中PS、RD、TP和SP呈明显的剂量依赖性 ;(2 )用雌激素受体阻断剂tamoxifen (1、5、10、30 μmol/L)预处理后 ,不能阻断E2 对压力感受器反射的抑制作用 ;(3)预先灌流NO合酶阻断剂 (L NAME ,10 0 μmol/L) ,可完全消除E2 (10 μmol/L)对压力感受器反射的抑制效应。以上结果表明 ,17β 雌二醇可通过非基因组机制抑制大鼠颈动脉窦压力感受器反射 ,其效应系E2 引起血管内皮细胞释放NO所致。     

动脉压力感受性反射受损后血浆和心脏、肾脏组织AngⅡ含量的变化

既往的研究表明,动脉压力感受性反射（ABR）功能下降在高血压靶器官损伤中起独立作用。为进一步研究ABR功能下降致器官损伤的可能机制,实验采用去窦弓神经（SAD）大鼠作为ABR受损的动物模型,分别测定清醒、自由活动状态下SAD及对照的假手术组大鼠24h动脉血压、心率、血压波动性（BPV）及心率波动性（HRV）。并采用放免法测定血浆、心脏和肾脏组织的血管紧张素Ⅱ（AngⅡ）含量。结果发现,SAD术后1周大鼠的24h平均收缩压（SBP）、舒张压（DBP）均显著高于对照组及术后18周的慢性期SAD大鼠。SAD术后18周,24h平均SBP、DBP及HR与假手术对照组均无显著差异;24h收缩压波动性（SBPV）和舒张压波动性（DBPV）均显著高于对照组大鼠。SAD大鼠术后1周的血浆、心脏和肾脏组织的AngⅡ含量及术后18周的血浆AngⅡ水平与对照组之间相比无显著差异。而在术后慢性期（18周）,SAD大鼠的心肌及肾组织AngⅡ含量显著高于假手术对照组大鼠。在术后18周时,接受慢性应激刺激的SAD大鼠,其血浆、心肌及肾组织中AngⅡ水平显著高于同处应激状态下的假手术对照组大鼠及未接受应激刺激的SAD大鼠。这些结果表明,SAD术后急性期血压增高,但在慢性期平均血压并无增高,仅BPV增高;慢性期心、肾组织内AngⅡ的分泌增加。在慢性期接受应激可致AngⅡ过度分泌,上述结果提示,BPV增高和心、肾组织AngⅡ含量升高与SAD大鼠发生心脏、肾脏等器官损害有关。     

链霉素对颈动脉窦压力感受器反射的抑制作用

在 2 3只隔离灌流颈动脉窦区的麻醉大鼠 ,观察了链霉素对颈动脉窦压力感受器反射的影响。结果如下 :(1)以链霉素 (10 0 μmol/L)隔离灌流大鼠左侧颈动脉窦区时 ,压力感受器反射机能曲线向左下方移位 ,曲线最大斜率 (PS)由 0 40± 0 0 1kPa降至 0 33± 0 0 1kPa (P <0 0 0 1) ,血压反射性下降 (reflexdecrease ,RD)幅度由 6 2 2±0 13kPa降至 5 0 2± 0 11kPa (P <0 0 0 1) ,阈压 (TP)、平衡压 (EP)和饱和压 (SP)则分别从 8 2 7± 0 2 5 ,12 71± 0 2 1和 2 4 41± 0 14kPa增至 10 33± 0 32 (P <0 0 1) ,13 33± 0 30 (P <0 0 1)和 2 6 11± 0 2 8kPa (P <0 0 1)。其中RD ,PS和TP的变化呈明显的剂量依赖性。 (2 )应用腺苷隔离灌流大鼠颈动脉窦区 ,引起颈动脉窦压力感受器反射的易化 ;在用链霉素预处理后 ,此易化效应不仅完全被阻断 ,且可使反射效应小于应用腺苷前的对照值。以上结果表明 ,链霉素对大鼠颈动脉窦压力感受器反射有明显的抑制作用。     

腺苷对颈动脉窦压力感受器反射的易化作用

在27只隔离灌流颈动脉窦区的麻醉大鼠,观察了腺苷（adenosine,Ado）对颈动脉窦压力感受器反射的影响。所得结果如下：（1）以 Ado（125μmol／L）隔离灌流大鼠左侧颈动脉窦区时,压力感受器机能曲线向左下方移位,曲线最大斜率（PS）由0．37±0．02增至0 55±0．02kPa／KPa（P＜0．001）,反射性血压下降幅度（RD）由5．53±0．12增至7．76±0．36KPa;阈压（TP）、平衡压（EP）和饱和压（SP）则分别从8．60±0．27,12．53±0．30和23．69±0．15下降至5．63± 0．11kPa,10．89±0．29KPa和20．18±0．55KPa（P＜0．01－0．001 ）。其中RD,PS和TP的变化呈明显的剂量依赖性。（2）用腺苷选择性 A1受体拮抗剂（8－cyclopentyl－l,3－dipropylianthene,0．134mmol／L）预处理后,Ado的上述反射效应即被阻断。（3）先给予KATP通道阻断剂格列苯脲（glibenclamide．10μmol／L）亦可取消腺苷对压力感受器反射的影响。以上结果表明, Ado对大鼠颈动脉窦压力感受器活动有易化作用,这一作用似与腺苷A1受体介导的KATP通道开放有关。     

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     

Ca^2＋参链霉素对大鼠颈动脉窦压力感受器反射影响中的作用

在２３只隔离灌流颈动脉窦区的麻醉大鼠上,观察了链霉素（ｓｔｒｅｐｔｏｍｙｃｉｎ,ＳＭ）对动脉压力感受器反射影响的离子机制。结果：（１）用ＳＭ（２００μｍｏｌ／Ｌ）隔离灌流大鼠颈动脉窦区时,压力感受器机能曲线向右上方移位,曲线最大斜率及反射性血压下降幅度均减小（Ｐ〈０．０１）,提示ＳＭ对压力感受器反射的抑制作用;（２）预先灌流高Ｃａ＾２＋溶液（４ｍｍｏｌ／Ｌ）后,可部分消除ＳＭ（２００μｍｏｌ／Ｌ）     

缓激肽抑制麻醉大鼠颈动脉窦压力感受器反射

在36只隔离灌流左侧颈动脉窦区的麻醉大鼠上观察了缓激肽(bradykinin,BK)对颈动脉窦压力感受器反射的影响.结果如下:(1)以BK (1.0μmol/L)隔离灌流大鼠颈动脉窦区时,压力感受器机能曲线向右上方移位,曲线的最大斜率(peak slope,PS)由0.44±0.14降至0.31±0.01(P<0.01),反射性血压下降幅度(reflex decrease,RD)由6.85±0.18 kPa降至4.46±0.16 kPa (P<0.01),阈压(TP)由7.76±0.20增至10.04±0.09kPa (P<0.05),其中RD,PS和TP的变化呈明显的剂量依赖性.(2)用环氧酶抑制剂消炎痛(indomethacin,10 μmol/L)预处理后,对BK (1.0μmol/L)抑制压力感受器的作用无影响; (3)预先灌流NO合酶阻断剂(L-NAME,100μmol/L),则可完全消除BK (1.0μmol/L)对压力感受器反射的抑制效应; (4)预先给予转换酶抑制剂(captopril,20μmol/L),可加强BK对压力感受器反射的抑制作用.以上结果表明:BK对大鼠颈动脉窦压力感受器反射有抑制作用,此作用系BK引起血管内皮细胞生成NO所致.     

八肽胆囊收缩素对大鼠颈动脉窦压力感受器反射的抑制作用

在36只隔离灌流颈动脉窦区的麻醉大鼠上,观察了八肽胆囊收缩素(cholecystokinin octapepide,CCK-8)对颈动脉窦压力感受器反射的影响。其结果如下：(1)以CCK-8(0．1、0．5、1．0μmol／L)隔离灌流颈动脉窦区时,压力感受器机能曲线向右上方移位,曲线最大斜率(peak slope,PS)减小,反射性血压下降幅度(reflex decrease,RD)减少,阈压(threshold pressure,TP)和饱和压(saturation pressure,SP)均增高。其中RD、PS和TP呈明显的剂量依赖性;(2)用CCK-8的非特异性受体拮抗剂丙谷胺(100μmol／L)预处理后,能明显减弱CCK-8(0．50mol/L)对压力感受器反射的抑制;(3)预先灌流一氧化氮合酶(nitric oxide synthase,NOS)阻断剂(L-NAME,100μmol／L),不能阻断CCK-8(0．5μmol/L)对压力感受器反射的影响;(4)用Ca^2 通道激动剂Bay K 8644(500nmol／L)预处理后,也能明显减弱CCK-8(0．5μmol／L)对压力感受器反射的抑制作用。以上结果提示,CCK-8是通过作用于颈动脉窦压力感受器神经元末梢上的受体而起到抑制作用的,其机制可能为抑制了牵张敏感性通道,致使Ca^2 离子内流减少,而与内皮细胞释放NO无关。     

活性氧、钙和心力衰竭

活性氧信号和钙信号广泛存在于机体内,两者相互作用,共同参与调节机体多种生理功能及病理过程。本文对这两个信号系统之间的相互作用及相关机制、在心力衰竭过程中的作用及可能的临床应用前景进行了综述。     

Redox-sensitive mechanisms underlying vascular dysfunction in heart failure

Abstract

Regardless of the progress in therapeutic drugs and devices to treat heart failure (HF) during the last few years, the clinical outcome of this disease remains deleterious. Impaired left ventricular function leads to neurohumoral activation, altered local shear forces, and hypoxia, which might give rise to inflammatory processes within the vasculature. Among those, the imbalance of the redox equilibrium toward increased concentrations of reactive oxygen species (ROS) is particularly important, as it affects the integrity of vascular function. Apart from injured or dysfunctional cardiomyocytes, vascular dysfunction has been demonstrated to play a crucial role in the development and progression of HF, which makes it an interesting target for new HF therapies. The mechanisms that initiate vascular dysfunction in HF pathogenesis and the processes leading to oxidative stress are not yet fully elucidated. However, oxidative stress promotes a variety of redox-sensitive mechanisms contributing to vascular dysfunction in HF. Here, we will summarize the sources of ROS in the vasculature, elucidate the impact of oxidative stress on functional and structural vascular remodeling, and consider the link to vascular dysfunction. Furthermore, we will point out the importance of vascular dysfunction in HF and discuss therapeutic options.     

Short-Term Effects of a Brief Respiratory Training on Baroreceptor Cardiac Reflex Function in Normotensive and Mild Hypertensive Subjects

Baroreceptor cardiac reflex sensitivity is reduced in hypertension and is considered a powerful prognostic factor in cardiovascular health. This study analyzes the acute effects of a brief respiratory training on baroreceptor sensitivity and on two new proposed baroreflex parameters: baroreceptor power (i.e., the percentage of cardiac beats regulated by the baroreflex) and effectiveness (i.e., the frequency in which the baroreflex responds to transient alterations in blood pressure). Twenty-two participants, 10 primary mild hypertensives and 12 normotensives, learned and practiced a respiratory pattern characterized by breathing at 6 bpm, with time of expiration being twice time of inspiration, predominantly abdominal, and with pursed lips. Baroreceptor parameters are differentiated in terms of increases (“up” sequences) or decreases (“down” sequences) in blood pressure. Irrespective of the groups, the breathing manipulation increased baroreceptor sensitivity (only in the “up” sequences), power, and effectiveness (only in the “down” sequences). These results suggest that this type of respiratory training could be used as a promising intervention to increase baroreceptor cardiac function in primary hypertension.     

Modification of Baroreceptor Cardiac Reflex Function by Biofeedback

Baroreceptor sensitivity (BRS) is considered a powerful prognostic factor in cardiovascular health. This study investigated the possibility of modifying the baroreflex cardiac function through biofeedback. Thirty-two psychology students underwent 3 biofeedback sessions, with four 5-min trials each, in which they had to increase and decrease baroreflex function. BRS was assessed by a system that analyzed baroreflex cardiac function on-line using a noninvasive spontaneous sequence method in the time domain. Baroreceptor parameters were differentiated in terms of blood pressure increases ("up" sequences) or blood pressure decreases ("down" sequences). BRS in the "up" sequences increased during the Increase Condition and decreased during the Decrease Condition. BRS in the "down" sequences decreased during the Decrease Condition but was unchanged during the Increase Condition. The increase in BRS during the Increase Condition was associated with a significant reduction in blood pressure and increase in heart period. The opposite cardiovascular changes were observed during the Decrease Condition. Suggestions for future research were discussed.     

Vascular redox imbalance in rats submitted to chronic exercise

Exercise training has been used for treatment/prevention of many cardiovascular diseases, but the mechanisms need to be clarified. Thus, our aim was to compare oxidative stress parameters between rats submitted to a swimming training and sedentary rats (control). Twelve male rats were divided into two groups: control and exercise training. The exercise training had daily 1 h swimming sessions for 8 weeks and a load (5% of its body mass) was placed in rat's tail. Thereafter the animals were killed, aorta and heart were surgically removed and blood was collected. Body mass gain, thiobarbituric acid reactive species (TBARS), carbonyl content, total reactive antioxidant potential (TRAP), total antioxidant reactivity (TAR), superoxide dismutase (SOD) activity and catalase (CAT) activity were evaluted. The trained rats showed a lower body mass gain and no modifications on heart. An increased SOD activity was observed on aorta after the training, but no changes were seen for CAT activity, which led to an increased SOD/CAT ratio. The arterial TBARS was also increased for trained rats. The decrease in TRAP in exercise training was the single modification on plasma. Our findings suggest that the increased SOD activity could play a role in vascular adaptations to exercise training. Copyright © 2010 John Wiley & Sons, Ltd.     

Mitochondrial network in the heart

Mitochondria are subcellular organelles that provide energy for the cell. They form a dynamic tubular network and play an important role in maintaining the cell function and integrity. Heart is a powerful organ that supplies the motivation for circulation, thereby requiring large amounts of energy. Thus, the healthiness of cardiomyocytes and mitochondria is necessary for the normal cardiac function. Mitochondria not only lie in the center of the cell apoptotic pathway, but also are the major source of reactive oxygen species (ROS) generation. Mitochondrial morphological change includes fission and fusion that are regulated by a large number of proteins. In this review we discuss the regulators of mitochondrial fission/fusion and their association with cell apoptosis, autophagy and ROS production in the heart.     

延髓头端腹外侧区一氧化氮与慢性心力衰竭大鼠心交感传入反射物的关系

为观察延髓头端腹外侧区(rostral ventrolateral medulla,RVLM)一氧化氮(N0)在慢性心力衰竭(chronic heart failure,CHF)大鼠增强的心交感传入反射(cardiac sympathetic afferent reflex,CSAR)中的作用,实验在去压力感受器神经支配的结扎冠状动脉诱发的CHF大鼠和假手术SD大鼠进行,记录电刺激心交感传入神经中枢端前后的血压和肾交感神经活动(renal sympathetic nerve activity,RSNA)变化以评价CSAR。结果显示：(1)CHF大鼠的CSAR显著增强;(2)RVLM微量注射NO合酶(NOS)抑制剂MeTC增强对照组大鼠的CSAR但对CHF大鼠的CSAR无显著影响;(3)RVLM微量注射NO供体S-nitroso-N-acetyl-penicillamine(SNAP)抑制CHF大鼠增强的CSAR;(4)S-methyl-L-thioeitruline（MeTC)仅增强对照组大鼠基础水平的RSNA,而SNAP抑制对照组和CHF大鼠基础水平的RSNA。结果表明RVLM中内源性NO的减少是导致CHF大鼠CSAR增强的重要机制之一。     

延髓头端腹外侧区一氧化氮与慢性心力衰竭大鼠心交感传入反射的关系

为观察延髓头端腹外侧区(rostral ventrolateral medulla,RVLM)一氧化氮(NO)在慢性心力衰竭(chronic heartfailure,CHF)大鼠增强的心交感传入反射(cardiac sympathetic afferent reflex,CSAR)中的作用,实验在去压力感受器神经支配的结扎冠状动脉诱发的CHF大鼠和假手术SD大鼠进行,记录电刺激心交感传入神经中枢端前后的血压和肾交感神经活动(renal sympathetic nerve activity,RSNA)变化以评价CSAR.结果显示:(1)CHF大鼠的CSAR显著增强;(2)RVLM微量注射NO合酶(NOS)抑制剂MeTC增强对照组大鼠的CSAR但对CHF大鼠的CSAR无显著影响;(3)RVLM微量注射NO供体S-nitroso-N-acetyl-penicillamine(SNAP)抑制CHF大鼠增强的CSAR;(4)S-methyl-L-thiocitmline(MeTC)仅增强对照组大鼠基础水平的RSNA,而SNAP抑制对照组和CHF大鼠基础水平的RSNA.结果表明RVLM中内源性NO的减少是导致CHF大鼠CSAR增强的重要机制之.     

Oxygen uptake kinetics in chronic heart failure: clinical and physiological aspects

One of the hallmark symptoms of patients with chronic heart failure (CHF) is exercise intolerance. Therefore, exercise testing has become an important tool for the evaluation and monitoring of heart failure. Whereas the maximal aerobic capacity (peak VO₂) is a reliable indicator of the severity and prognosis of heart failure, submaximal exercise parameters may be more closely related to the ability to perform daily activities. As such, oxygen (O₂) uptake kinetics, describing the rate change of O₂ uptake during onset or recovery of submaximal constant-load exercise (O₂ onset and recovery kinetics, respectively), have been shown to be useful parameters for objectively evaluating the functional capacity of CHF patients. However, their evaluation in this population is not a routine part of daily clinical practice. Possible reasons for this include a lack of standardisation of the assessment methodology and a limited number of studies evaluating the clinical use of O₂ uptake kinetics in CHF patients. In addition, the pathophysiological mechanisms underlying the delay in O₂ uptake kinetics in these patients are not completely understood. This review discusses the current literature on the clinical potency and physiological determinants of O₂ uptake kinetics in CHF patients and provides directions for future research. (Neth Heart J 2009;17:238–44.)     

Cardiopulmonary exercise test predicts sustained ventricular arrhythmias in chronic heart failure

Background

The cardiopulmonary exercise test (CPX) is an affordable tool for risk prediction in patients with chronic heart failure (CHF). We aimed to determine the role of CPX parameters in predicting the risk of incidence of sustained ventricular arrhythmias (SVA) in CHF.

Methods

Sixty-one consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent CPX and were followed for 327 ± 247 days. Clinical follow-up was performed every month and anticipated in case of re-hospitalisation for cardiac disease. Incidence of SVA was evaluated by direct clinical examination (ECG, ambulatory ECG).

Results

Patients with episodes of SVA (N 14) showed lower values of pVO2 and PetCO2, and higher values of VE/VCO2, VE/VCO2 slope, and VE%. After correction for age, gender, diabetes, ischaemic heart disease and left ventricular ejection fraction, peak VO2 (hazard ratio (HR) 0.68, 95 % confidence interval (CI) 0.51–0.91, p < 0.05), VE% (HR 1.38, 95 % CI 1.04–1.84, p < 0.05), VE/VCO2 (HR 1.38, 95 % CI 1.04–1.82, p < 0.05), VE/VCO2 slope (HR 1.77, 95 % CI 1.31–2.39, p < 0.01), PetCO2 (HR 0.66, 95 % CI 0.50–0.88, p < 0.01) were found as predictors of SVA. At Kaplan-Meier analysis, lower event-free rates were found in subjects with peak VO2 values below median (log rank p < 0.05), values of VE/VCO2 above mean (p < 0.05), higher VE/VCO2 slope tertiles (p <0.05), and values of PetCO2 below median (p < 0.05).

Conclusions

CPX provides prognostic independent information for risk of SVA in subjects with CHF.