应激性心肌病发病机制的研究进展

应激性心肌病(stress cardiomyopathy,SCM)是一种在精神或躯体应激后,出现严重但可逆的左室局部收缩功能异常的心脏疾病。本病的发病机制尚不清楚,目前可能的机制包括氧化应激、冠状动脉微血管功能障碍、心肌炎症、儿茶酚胺毒性、雌激素缺乏等,但最主要是由儿茶酚胺过度释放所致的心脏毒性。尽管大部分应激性心肌病患者可以康复,但在发病过程中严重的并发症发生率非常高,以至于需要重症监护治疗。本文旨在对应激性心肌病发病机制的研究现状进行综述。     

自发性高血压大鼠血浆高血压因子的升压机制

自发性高血压大鼠血浆高血压因子的升压机制赵睿珊,胡晓东,王辅才,吴代英（河北省医学科学院实验医学研究所石家庄０５００２１）本工作研究在自发性高血压大鼠（ＳＨＲ）的血浆中存在的一种具有独特性质的高血压因子（ＨＦ）的作用,从而探讨高血压发病的原因、机制和...     

醛固酮通过儿茶酚胺收缩血管平滑肌

醛固酮可能参与原发性及继发性高血压时的血压升高,降压治疗不易奏效常与醛固酮水平增高有关。然而,醛固酮的升压效应与临床观察到的水、电解质平衡改变并无明确联系。故有人推测,醛固酮的升压作用与其肾内盐皮质激素作用无关,可能是通过其它机制实现的。     

中脑导水管周围灰质NO在应激大鼠高血压形成中的作用及其机制探讨

目的：探讨大鼠中脑导水管周围灰质（PAG）内NO在应激性高血压（SIH）发病中的作用。方法：采用电击足底结合噪声建立应激性高血压大鼠模型,NADPH－d组化方法显示PAG内一氧化氮合酶（NOS）阳性神经元的变化,核团微注法和放免法检测PAG内微量注射L－NNA对动物血压和延髓头端腹外侧区（RVLM）内Ach含量的影响。结果：（1）应激性高血压大鼠血压升高,PAG背外侧区NOS阳性神经元数量明显减少,平均灰度值增高,且RVLM内Ach含量也增多。（2）PAG内微量注射L－NNA 100mmol/L 0.1μl后,对照组大鼠的平均动脉压（MAP）升高,RVLM内Ach含量增多,而应激性高血压组大鼠MAP的变化显著小于对照组。结论：应激性高血压大鼠PAG内NOS阳性神经元发生的可塑性变化,可能经RVLM内Ach介导,参与了该病的形成。     

钙及钙拮抗剂与原发性高血压

原发性高血压的发病机制目前还不十分清楚,可能与遗传、精神神经、内分泌、细胞膜缺陷等因素有关。本文综述1988年5月在日本举行的第二届原发性高血压机制和治疗的国际学术会议(高血压机制与钙)部分论文,着重讨论原发性高血压发病机制的膜钙理论和钙在血压调节中的作用以及钙拮抗剂对原发性高血压的治疗作用。一、细胞膜对Ca~(2 )处理的异常可能是原发性高血压的发病机制之一     

抑郁症与代谢综合征的神经内分泌免疫联系

随着社会竞争日益加剧,生活和工作节奏加快,人们所承受的压力和挑战(应激)也越来越大。长时间、高强度的应激会打破机体神经内分泌免疫网络原有的稳态,导致多种疾病的发生。近年来,抑郁症以其高发性、高致残性以及对家庭和社会的高负担而引起人们的高度重视,关于其发病机制和防治措施的研究方兴未艾。另外,在神经内分泌免疫紊乱的催生下,肥胖、糖尿病、高血脂、高血压等代谢相关问题也变得越发显著。近年来,愈来愈多的研究提示,抑郁症和代谢综合征的发病可能拥有共同的神经内分泌免疫基础,两类疾病也很可能在一定程度上互为因果。本文结合国内外研究现状,梳理总结相关研究成果,对两类疾病的神经内分泌免疫联系作一综述。     

红细胞抗高血压因子降压作用的进一步研究

我们曾报道原发性高血压患者(EHS)红细胞抗高血压因子(AHF)具有缓慢而持久的降压作用。本工作表明,AHF对卒中易感型自发性高血压大鼠(SHRsp)还具有快速短暂的降压作用,注射AHF后10—30s,SHRsp收缩压从原水平的26.8±1.7kPa降至20.1±1.5kPa(P<0.001)。正常人和大鼠红细胞AHF的降压作用明显强于EHS和高血压大鼠AHF。此外我们还发现EHS血浆中存在升压物质。以上结果提示,AHF缺乏和升压物质含量相对较高可能是原发性高血压发病的一个重要原因。     

神经递质转运蛋白在应激性心肌病发病中的潜在作用

应激性心肌病是强烈应激诱发的心血管急症,自20世纪90年代初Dote首次报告后,世界各地临床报告病例逐年攀升。发病机制迄今尚不完全清楚,但交感神经过度激活,大量释放去甲肾上腺素在本病发生中起重要作用。根据相关研究进展,主要综述神经递质转运蛋白调控神经递质及交感神经活性在这一神经源性心脏病中可能发挥的重要作用。     

大鼠尾核多巴胺受体抑制对黑质升压作用的影响

黑质 纹状体多巴胺系统是中枢多巴胺系统的重要组成成分。资料表明 ,谷氨酸钠微量注入及电刺激黑质 (ｓｕｂｓｔａｎｔｉａｎｉ ｇｒａ,ＳＮ)均可使血压升高 ,幼年自发性高血压大鼠 (ｓｐｏｎｔａｎｅｏｕｓｌｙＨｙｐｅｒｔｅｎｓｉｖｅＲａｔ,ＳＨＲ)脑室注射 6 羟多巴胺使额皮质和尾状核中ＤＡ下降 ,并能削弱ＳＨＲ高血压的发展 ,电解损毁黑质使ＳＨＲ血压升高延迟 ,这提示黑质ＤＡ能神经元可能通过中枢机制发挥其升压作用 ,并可推测黑质 纹状体ＤＡ系统在高血压发展中起作用。本工作旨在在确定黑质升压反应的基础上检验尾核在黑质升压…     

内源性中枢血管紧张素Ⅱ在慢性应激大鼠血压高反应性中的作用

心理生理学研究表明,高血压病人对应激刺激的反应性要高于正常血压者,高血压息者对刺激产生的血压变化在幅度与时限上均强于正常血压者。动物实验表明,与Wistar-Kyoto(WKY)大鼠相比,自发性高血压大鼠(SHR)对环境心理应激的心血管反应性增强,并可能与遗传有关。在SHR的高血压维持中血管紧张素Ⅱ(AⅡ)起一定作用。本实验探讨内源性中枢AⅡ在慢性应激Wistar大鼠动脉血压高反应     

Nociceptin in rVLM mediates electroacupuncture inhibition of cardiovascular reflex excitatory response in rats.

Electroacupuncture (EA) at Neiguan-Jianshi acupoints through an opioid mechanism inhibits the cardiovascular pressor response induced by mechanical stimulation of the stomach. Because nociceptin also may regulate cardiovascular activity through its action in the brain stem, we hypothesized that this neuromodulator serves a role in the EA-related inhibitory effect. Blood pressure in ventilated male Sprague-Dawley rats (400-600 g) anesthetized by ketamine and alpha-chloralose was measured during balloon inflation of the stomach. Gastric distension with 6-8 ml of air induced consistent pressor reflexes of 26 +/- 1 mmHg that could be repeated every 10 min for 100 min. When nociceptin (10 nM) was microinjected into the rostral ventrolateral medulla (rVLM), the pressor response induced by gastric distension was inhibited by 68 +/- 6%. Thirty minutes of EA also decreased the reflex response by 75 +/- 11%; microinjection of saline into the rVLM did not alter the inhibitory effect of EA. In contrast, microinjection of a nociceptin receptor antagonist into the rVLM promptly reversed the EA response. Pretreatment with the opioid receptor antagonist naloxone did not influence the EA-like inhibitory effect of nociceptin on the distension-induced pressor reflex (22 +/- 1 to 8 +/- 2 mmHg). Furthermore, a mu-opioid receptor agonist microinjected into the rVLM after microinjection of a nociceptin receptor antagonist during EA promptly reversed the nociceptin receptor antagonist-related inhibition of the EA effect. Thus, in addition to the classical opioid system, nociceptin, through opioid receptor-like-1 receptor stimulation in the rVLM, participates in the modulatory influence of EA on reflex-induced increases in blood pressure.     

室旁核在刺激中脑防御反应区诱发防御性升压反应中的作用

雄性ＳＤ大鼠,用乌拉坦（７００ｍｇ／ｋｇ）和氯醛糖（３０ｍｇ／ｋｇ）腹腔麻醉。实验结果：（１）每隔５ｍｉｎ电刺激中脑导水管周围灰质背侧部“防御反应区”（ｄＰＡＧ）,持续观察５０ｍｉｎ,可见恒定的升压反应。若电解毁单侧室旁核（ＰＶＮ）区。１ｈ后,电刺激中脑ｄＰＡＧ区诱发的升压反应幅度部分减小。而损毁穹隆部、下丘脑前部、下丘脑背内侧核、下丘脑腹内侧核则无上述效应。（２）电刺激或微量注射高半胱胺酸（ＤＬ     

安定降低家兔血压和减少刺激下丘脑诱发室性期前收缩的机制分析

家兔62只,用乌拉坦(700mg/kg)和氯醛醣(35mg/kg)静脉麻醉,三碘季铵酚制动,在人工呼吸下进行实验。用电刺激下丘脑近中线区的方法诱发室性期前收缩(HVE)。静脉注射安定(0.5mg/kg)可降低基础血压(BP),减弱刺激下丘脑引起升压反应(指收缩压峰值SBP_(max))和减少HVE。在双侧延髓腹外侧头端区(rVLM)微量注射氟安定(200μg溶于0.5μl中),γ-氨基丁酸(GABA)(6μg溶于0.5μl中)均能降低BP、SBP_(max)和减少HVE,若微量注射印防己毒素(7.5μg溶于0.5μl中)则可使BP上升并增多HVE。而于双侧延髓腹外侧尾端区(cVLM)微量注射同样剂量氟安定、GABA则无上述反应。安定降低BP、SBP_(max)和减少HVE的作用可被双侧rVLM区微量注射GABA受体拮抗剂荷包牡丹碱(3μg溶于0.5μl中)或印防己毒素所消除,但在双侧rVLM区微量注射甘氨酸受体拮抗剂士的宁(1μg溶于0.5μl中)、阿片受体拮抗剂纳洛酮(0.5μg溶于0.5μl中)、胆碱能阻断药阿托品(0.25μg溶于0.5μl中)、东莨菪碱(1.5μg溶于0.5μl中)后仍然存在。 上述结果提示,在双侧rVLM应用GABA受体拮抗剂可消除安定降低BP、SBP_(max)和减少HVE的作用,安定降低BP、SBP_(max)和减少HVE的作用可能通过GABA这一中间环节,而胆碱能受体、阿片受体、甘氨酸受体可能不起重要作用。     

Role of glutamate in a visceral sympathoexcitatory reflex in rostral ventrolateral medulla of cats

The rostral ventrolateral medulla (rVLM) is involved in processing visceral sympathetic reflexes. However, there is little information on specific neurotransmitters in this brain stem region involved in this reflex. The present study investigated the importance of glutamate and glutamatergic receptors in the rVLM during gallbladder stimulation with bradykinin (BK), because glutamate is thought to function as an excitatory neurotransmitter in this region. Stimulation of visceral afferents activated glutamatergic neurons in the rVLM, as noted by double-labeling with c-Fos and the cellular vesicular glutamate transporter 3 (VGLUT3). Visceral reflex activation significantly increased arterial blood pressure as well as extracellular glutamate concentrations in the rVLM as determined by microdialysis. Barodenervation did not alter the release of glutamate in the rVLM evoked by visceral reflex stimulation. Iontophoresis of glutamate into the rVLM enhanced the activity of sympathetic premotor cardiovascular rVLM neurons. Also, the responses of these neurons to visceral afferent stimulation with BK were attenuated significantly (70%) by blockade of glutamatergic receptors with kynurenic acid. Microinjection of either an N-methyl-D-aspartate (NMDA) receptor antagonist 2-amino-5-phosphonopentanate (25 mM, 30 nl) or an dl-alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA) receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (2 mM, 30 nl) into the rVLM significantly attenuated the visceral sympathoexcitatory reflex responses. These results suggest that glutamate in the rVLM serves as an excitatory neurotransmitter through a baroreflex-independent mechanism and that both NMDA and AMPA receptors mediate the visceral sympathoexcitatory reflex responses.     

延髓头端腹外侧区血管升压素能机制在应激性高血粘度中的作用

观察延髓头端腹外侧区（ｒＶＬＭ）微量注射血管升压素（ＡＶＰ）能否影响正常大鼠的血压和血粘度,并分析ｒＶＬＭ内ＡＶＰ能机制在清醒大鼠经悬吊加束缚引起应激性升压反应和高血粘度中的影响。结果如下：⑴正常大鼠双侧ｒＶＬＭ微量注射ＡＶＰ（每侧０．５μｇ／０．５μｌ）,可引起血压和血粘度升高;此作用可被事先在同一位置微量注射ＡＶＰ－Ｖ１受体拮抗剂ｄ（ＣＨ２）５「Ｔｙｒ（Ｍｅ）＾２」ＡＶＰ（每侧０．１μｇ／０．     

头端延髓腹外侧区在侧脑室注射新斯的明所致升压中的作用

实验在47只乌拉坦(700m/kg)、氯醛糖(35mg/kg)麻醉,肌肉麻痹,人工呼吸的家兔上进行。结果观察到,侧脑室注射(icv)新斯的明引起血压升高,心率(HR)先减慢后有加快趋势,股动脉血流量(FBF)与股动脉血管通道性(COND)减小,左心室内压(LVP)增大,肾交感神经放电(RND)增加,延髓腹外侧头端(rVLM)微量注射阿托品则引起血压下降,HR减慢,FBF与COND增加,LVP与RND减小,若在icv新斯的明之前,预先向rVLM注入阿托品,可阻断新斯的明的升压效应,上述结果提示,rVLM是icv新斯的明升压效应的重要部位,rVLM区M受体功能完整是这种升压作用的关键因素。     

Effect of electroacupuncture on pressor reflex during gastric distension

The effect of electroacupuncture (EA) on the reflex cardiovascular response induced by mechanical distension of the stomach was studied in ventilated male Sprague-Dawley rats anesthetized by ketamine and alpha-chloralose. Repeated balloon inflation of the stomach to produce 20 mmHg tension on the gastric wall induced a consistent rise in mean arterial pressure, while heart rate (372 +/- 22 beats/min) was unchanged. This response was reversed by transection of the splanchnic nerves. Bilateral application of EA (1-2 mA, 2 Hz) at Neiguan-Jianshi acupoints (pericardial meridian, Pe 5-6) over the median nerve for 30 min significantly decreased the pressor response from 33 +/- 6 to 18 +/- 4 mmHg (n = 7, P < 0.05). This effect began after 10 min of EA and continued for 40 min after termination of EA. EA at Zusanli-Shangquxu acupoints (stomach meridian, St 36-37) over the deep peroneal nerve similarly inhibited the pressor response. The effect lasted for 10 min after EA was stopped (n = 6, P < 0.05), while EA at Guangming-Xuanzhong acupoints (gallbladder meridian, GB 37-39) over the superficial peroneal nerve did not inhibit the pressor response. Naloxone injected intravenously (n = 6) immediately after termination of EA or administered by microinjection into the rostral ventrolateral medulla (rVLM) 25 min after initiation of EA (n = 6) reversed the inhibition by EA, suggesting an opiate mechanism, including the rVLM, was involved.     

Medullary substrate and differential cardiovascular responses during stimulation of specific acupoints

Electroacupuncture (EA) at P5-P6 acupoints overlying the median nerve reduces premotor sympathetic cardiovascular neuronal activity in the rostral ventral lateral medulla (rVLM) and visceral reflex pressor responses. In previous studies, we have noted different durations of influence of EA comparing P5-P6 and S36-S37 acupoints, suggesting that point specificity may exist. The purpose of this study was to evaluate the influence of stimulating P5-P6 (overlying the median nerve), LI4-L7 (overlying branches of the median nerve and the superficial radial nerve), LI6-LI7 (overlying the superficial radial nerve), LI10-LI11 (overlying the deep radial nerves), S36-S37 (overlying the deep peroneal nerves), or K1-B67 (overlying terminal branches of the tibial nerves) specific acupoints, overlying deep and superficial somatic nerves, on the excitatory cardiovascular reflex and rVLM responses evoked by stimulation of chemosensitive receptors in the cat's gallbladder with bradykinin (BK) or direct splanchnic nerve (SN) stimulation. We observed point-specific differences in magnitude and duration of EA inhibition between P5-P6 or LI10-LI11 and LI4-L7 or S36-S37 in responses to 30-min stimulation with low-frequency, low-current EA. EA at LI6-LI7 and K1-B67 acupoints as well as direct stimulation of the superficial radial nerve did not cause any cardiovascular or rVLM neuronal effects. Cardiovascular neurons in the rVLM, a subset of which were classified as premotor sympathetic cells, responded to brief (30 s) stimulation of the SN as well as acupoints P5-P6, LI10-LI11, LI4-L7, S36-S37, LI6-LI7, or K1-B67, or underlying somatic pathways in a fashion similar to the reflex responses. In fact, we observed a significant linear relationship (r(2) = 0.71) between the evoked rVLM response and reflex change in mean arterial blood pressure. In addition, EA stimulation at P5-P6 and LI4-L7 decreased rVLM neuronal activity by 41 and 12%, respectively, for >1 h, demonstrating that prolonged input into the medulla during stimulation of somatic nerves, depending on the degree of convergence, leads to more or less inhibition of activity of these cardiovascular neurons. Thus EA at acupoints overlying deep and superficial somatic nerves leads to point-specific effects on cardiovascular reflex responses. In a similar manner, sympathetic cardiovascular rVLM neurons that respond to both visceral (reflex) and somatic (EA) nerve stimulation manifest graded responses during stimulation of specific acupoints, suggesting that this medullary region plays a role in site-specific inhibition of cardiovascular reflex responses by acupuncture.     

延髓腹外侧头端区在第四脑室注射 P物质所致升压中的作用

实验用乌拉坦麻醉、肌内麻痹、人工呼吸的家兔。将Ｐ物质（ＳＰ,０．８ｎｇ／ｋｇ溶于１０μｌ人工脑脊液中）注入第四脑室引起肺动脉压（ＰＡＰ）升高或降低,但对坟反应为主。与此同时,颈劝脉压（ＣＡＰ）上升,心率（ＨＲ）减慢;而在第四及室内注入同容积的人工脑脊液对ＰＡＰ,ＣＡＰ和ＨＲ无明显影响。若在ｉｖｔＳＰ之前,预先向双侧延髓腹外侧头端区微量注射ＳＰ受体拮抗剂－ＳＰ（５＝１０ｎｇ溶于０．５μｌ人工脑脊液中     

Role of glutamate in the rostral ventrolateral medulla in acupuncture-related modulation of visceral reflex sympathoexcitation

Visceral sympathoexcitatory reflexes induced by stimulation of the gallbladder with bradykinin (BK) are attenuated by electroacupuncture (EA) at Neiguan-Jianshi (P5-6) acupoints located over the median nerve. Previous studies have shown that neurons in the rostral ventrolateral medulla (rVLM) receive convergent input from visceral organs and somatic nerves (activated by EA). Glutamate (Glu), an important excitatory neurotransmitter in the rVLM, processes visceral sympathoexcitatory cardiovascular reflexes. In the present study, we determined the relation between EA-mediated opioidergic modulation of visceral cardiovascular responses and Glu. Reflex cardiovascular responses were evoked by application of BK to the gallbladder before and after EA in anesthetized cats. Glu concentrations ([Glu]) were measured by HPLC from samples collected by microdialysis probe(s) inserted unilaterally or bilaterally into the rVLM. BK-induced reflex responses and [Glu] were attenuated by 45% and 70%, respectively, after 30 min of EA (n = 6). EA alone did not change [Glu] in the rVLM (n = 6, P > 0.05). However, microdialysis of naloxone (100 mM) into the rVLM reversed EA-related inhibition of blood pressure and [Glu] (n = 5). Immunohistochemical visualization showed that delta-opioid receptors colocalized with, and were in close apposition to, vesicular Glu transporter 3- and c-Fos-double-labeled perikarya and processes of rVLM neurons after gallbladder stimulation with BK. These data suggest that EA attenuates BK-induced visceral sympathoexcitatory reflexes through opioid-mediated inhibition of Glu's action in the rVLM.