目的:观察12周有氧运动对慢性心力衰竭大鼠心功能、交感神经活性和运动能力的影响并探索其可能机制。方法:Wistar大鼠通过结扎冠状动脉建立心梗后心衰模型,术后4周后随机分为假手术安静组(SH组)、心梗安静组(MI组)和心梗运动组(MI-Ex组)...目的:观察12周有氧运动对慢性心力衰竭大鼠心功能、交感神经活性和运动能力的影响并探索其可能机制。方法:Wistar大鼠通过结扎冠状动脉建立心梗后心衰模型,术后4周后随机分为假手术安静组(SH组)、心梗安静组(MI组)和心梗运动组(MI-Ex组),MI-Ex组进行12周跑台运动,SH组和MI组保持安静状态。12周结束后,利用递增负荷跑台实验测定运动能力,包括力竭时间、力竭距离和最大跑速;超声心动图检测心脏结构与功能,包括左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、缩短分数(FS)、左室射血分数(LVEF)和心率(HR);高压液相色谱法测定心肌和血浆去甲肾上腺素(NE)水平;RT-PCR和Western Blot法检测心肌β1肾上腺素能受体(β1-AR)、G蛋白偶联受体激酶2(GRK2)和酪氨酸羟化酶(TH)基因和蛋白表达水平。结果:与SH组比较,MI组力竭时间、力竭距离和最大跑速均显著性降低(P<0.01);BW、FS和LVEF下降(P<0.01),HW、HW/BW、LVESD、LVEDD和HR升高(P<0.01);血浆NE升高,心肌NE降低(P<0.01);心肌β1-AR、TH m RNA和蛋白水平降低(P<0.01),GRK2 m RNA和蛋白水平升高(P<0.01)。与MI组比较,MI-Ex组力竭时间、力竭距离和最大跑速均显著性升高(P<0.01),LVESD和LVEDD降低(P<0.01),FS和LVEF升高(P<0.01);血浆NE降低,心肌NE升高(P<0.01);心肌β1-AR、TH m RNA和蛋白水平升高(P<0.01),GRK2 m RNA和蛋白水平降低(P<0.01)。结论:长期有氧运动增强慢性心衰大鼠心脏交感活性并改善心功能和运动能力,其机制可能与心肌GRK2表达下调以及β1-AR表达上调有关。展开更多
Background Increased renal sympathetic nerve activity can result in diuretic resistance in patients with chronic congestive heart failure. We investigated the effect of regional renal nerve blockade on the patients wi...Background Increased renal sympathetic nerve activity can result in diuretic resistance in patients with chronic congestive heart failure. We investigated the effect of regional renal nerve blockade on the patients with chronic refractory heart failure and diuretic resistance. Methods Eighteen patients with chronic refractory heart failure were enrolled （mean age （64＋11） years）. The patients were randomly divided into two groups （renal nerve blockade group and standard therapy group, n=9 each）. Renal nerve blockade was performed by percutaneous injection of local anaesthetic under computed tomographic guidance. Heart rate, mean arterial blood pressure, plasma and urine electrolytes, neurohormones, factional excretion of sodium （FENa）, 24-hour urine volume were monitored at baseline and the first 24 hours after therapy. Dyspnea and oedema were also evaluated. The major adverse cardiovascular events （MACE）, plasma brain natriuretic peptide （BNP） level and left ventricular ejection fraction （LVEF） were compared between the two groups during the 3-12 months follow-up period. Results No complication was observed during the acute phase of renal nerve blockade. After renal nerve blockade, the 24-hour urine volume and FENa were significantly increased, while the level of plasma rennin, angiotensin II, aldosterone BNP and atrial natriuretic peptide as well as dyspnea and oedema were significantly reduced in renal nerve blockade group compared with baseline and standard therapy group. During three to 12 months of follow-up, the rate of MACE and plasma BNP level were significantly lower, while LVEF was significantly higher in renal nerve blockade group than those in standard therapy group. Conclusion Regional renal nerve blockade may be a safe and effective treatment for patients with chronic refractory heart failure.展开更多
Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury（SCI）. Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics ...Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury（SCI）. Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics due to deregulated sympathetic outflow. As a result of the reduced sympathetic activity, patients with SCI may experience hypotension, cardiac dysrhythmias, and hypothermia post-injury. In the chronic phase, changes within the CNS and blood vessels lead to orthostatic hypotension and life-threatening autonomic dysreflexia（AD）. AD is characterized by an episodic, massive sympathetic discharge that causes severe hypertension associated with bradycardia. The syndrome is often triggered by unpleasant visceral or sensory stimuli below the injury level. Currently the only treatments are palliative - once a stimulus elicits AD, pharmacological vasodilators are administered to help reduce the spike in arterial blood pressure. However, a more effective means would be to mitigate AD development by attenuating contributing mechanisms, such as the reorganization of intraspinal circuits below the level of injury. A better understanding of the neuropathophysiology underlying cardiovascular dysfunction after SCI is essential to better develop novel therapeutic approaches to restore hemodynamic performance.展开更多
Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is...Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.展开更多
Resistant hypertension remains a major clinical problem despite the available multidrug therapy.Over the next decades,its incidence will likely increase given that it is strongly associated with older age and obesity....Resistant hypertension remains a major clinical problem despite the available multidrug therapy.Over the next decades,its incidence will likely increase given that it is strongly associated with older age and obesity.Resistant hypertension patients have an increased cardiovascular risk,thus effective antihypertensive treatment will provide substantial health benefits.The crosstalk between sympathetic nervous system and kidneys plays a crucial role in hypertension.It influences several pathophysiological mechanisms such as the central sympathetic tone,the sodium balance and the systemic neurohumoral activation.In fact,studies using several animal models demonstrated that the renal denervation prevented and attenuated hypertension in multiple species.Large reductions in blood pressure were also observed in malignant hypertension patients submitted to sympathectomy surgeries.However,these approaches had an unacceptably high rates of periprocedural complications and disabling adverse events.Recently,an innovative non-pharmacological therapy that modulates sympathetic activation has been successfully developed.Renal sympathetic percutaneous denervation is an endovascular procedure that uses radiofrequency energy to destroy the autonomic renal nerves running inside the adventitia of renal arteries.This method represents a promising new approach to the strategy of inhibiting the sympathetic nervous system.The aim of this review is to examine the background knowledge that resulted in the development of this hypertension treatment and to critically appraise the available clinical evidence.展开更多
Neuropathic pain and the other abnormalities of sensation induced by axon injury or by peripheral nerve inflammation should result from functional compensations of the injured neurons during their regeneration. Ectopi...Neuropathic pain and the other abnormalities of sensation induced by axon injury or by peripheral nerve inflammation should result from functional compensations of the injured neurons during their regeneration. Ectopic distribution of proteins related to Na+, K+ and Ca2+ channels as well as of receptors on both membranes of injured axon and its cell body becomes a main pacemaker from which spontaneous ectopic afferent of primary sensatory neurons and crosstalk between neurons occur. Abnormal ectopic afferent activities lead to disorders of the sensation, such as hyperalgesia, allodynia, spontaneous pain and paraesthesia. Administration of some ion channel agents and/or α2-adrenergic blockers has shown efficiency in preventing neuropathic pain development and in relieving neuropathic pain.展开更多
目的观察艾贝宁对神经源性肺水肿交感活性亢进的抑制作用。方法 97例神经源性肺水肿患者分对照组(C)、倍他乐克组(M)、艾贝宁组(D),测定血浆去甲肾上腺素(NE)、肾上腺素(E)评估交感活性,血浆脑型利钠肽(BNP)并行心脏超声等评估心功能状...目的观察艾贝宁对神经源性肺水肿交感活性亢进的抑制作用。方法 97例神经源性肺水肿患者分对照组(C)、倍他乐克组(M)、艾贝宁组(D),测定血浆去甲肾上腺素(NE)、肾上腺素(E)评估交感活性,血浆脑型利钠肽(BNP)并行心脏超声等评估心功能状态,记录呼吸机参数评估呼吸机支持力度。结果与其他组相比,D组血浆NE(4.51±0.24 vs 3.98±0.49 vs 3.61±0.31,P<0.05)、E(3.23±0.51 vs 3.01±0.67 vs 2.19±0.29,P<0.05),交感活性明显受抑,BNP(4783.59±179.33 vs 3584.26±164.71 vs 3126.88±158.72,P<0.05),左室射血分数显著提高(LVEF:47.49%±1.29%vs 53.22%±2.13%vs 58.91%±2.04%,P<0.05)心功能改善。机械通气时间缩短(P<0.05),呼吸机支持力度下降(P<0.05),肺功能好转。结论艾贝宁可有效抑制神经源性肺水肿患者交感活性亢进,改善心肺功能。展开更多
Greater fluctuations in office blood pressure increase the risk of stroke and blood pressure volatility is an important risk factor for cardiovascular events. Effects of sympathetic and parasympathetic nerve on blood ...Greater fluctuations in office blood pressure increase the risk of stroke and blood pressure volatility is an important risk factor for cardiovascular events. Effects of sympathetic and parasympathetic nerve on blood pressure regulation are well known, however, those on visit-to visit variation remains unclear. Aim of this study is to clarify the contribution of sympathetic and parasympathetic balance on blood pressure fluctuation. Methods: We enrolled 23 outpatients with essential hypertension. We measured blood pressure, and pulse rate at clinic 14 times in a row and calculated coefficient of variance (CV) as visit-to-visit variability. The velocity of pupil contraction, miosis (VC) and dilation, mydriasis (VD) was determined from pupillary function test. Results: Systolic blood pressure and diastolic blood pressure were not significantly correlated with VC, VD and VD/VC. Heart rate was not correlated with VC and VD, but significantly correlated with VD/VC. CV of systolic blood pressure, diastolic blood pressure and heart rate were not significantly correlated with VC or VD. Ratio of VD to VC significantly negative correlated with CV of blood pressure, diastolic blood pressure, and heart. Value of VD was significantly correlated with value of VC. Conclusion: Visit-to-visit variability of blood pressure and heart rate is not related with sympathetic or parasympathetic tone independently but augmented by the impaired sympathetic and parasympathetic balance.展开更多
Objective: To study sympathetic-sensory coupling in chronically compressed dorsal root ganglion (DRG) neurons in rats. Methods: In chronically compressed DRG model, the spontaneous activity of single fiber from the in...Objective: To study sympathetic-sensory coupling in chronically compressed dorsal root ganglion (DRG) neurons in rats. Methods: In chronically compressed DRG model, the spontaneous activity of single fiber from the injured DRG neuron was recorded, and lumbar sympathetic trunk was electrical stimulated to study the sympathetic modulation of spontaneous activities in injured DRG neurons. Results: Fifty-seven percent of spontaneous active neurons of injured DRG responded to sympathetic stimulation. The responses included simple excitation, excitation followed by inhibition and simple inhibition. The responses enhanced with the increase of sympathetic stimulation time. The responses to sympathetic stimula- tion could be blocked by intravenously injection of phentolamine, a-adrenorecepor antagonist. Fifty-three percent of injured DRG responded to norepinephrine (NE). The responses to NE were similar to those induced by sympathetic stimulation. Conclusion: Sympathetic-sensory coupling is virtually present in chronic compressed DRG neurons. NE released from sympathetic nerve terminals acts on a-adrenorecepor to influence spontaneous activities of injured DRG neurons.展开更多
Our previous studies have shown that the cardiac sympathetic afferent reflex is enhanced in rats with chronic heart failure （CHF） induced by coronary artery ligation and contributes to the over-excitation of sympath...Our previous studies have shown that the cardiac sympathetic afferent reflex is enhanced in rats with chronic heart failure （CHF） induced by coronary artery ligation and contributes to the over-excitation of sympathetic ac- tivity. We sought to determine whether sympathetic activity and cardiac sympathetic afferent reflex were en- hanced in adriamycin-induced CHF and whether angiotensin II （Ang II） in the paraventricular nucleus （PVN） was involved in enhancing sympathetic activity and cardiac sympathetic afferent reflex. Heart failure was induced by intraperitoneal injection of adriamycin for six times during 2 weeks （15 mg/kg）. Six weeks after the first injec- tion, the rats underwent anesthesia with urethane and a-chloralose. After vagotomy and baroreceptor denervation, cardiac sympathetic afferent reflex was evaluated by renal sympathetic nerve activity and mean arterial pressure （MAP） response to epicardial application of capsaicin （1.0 nmol）. The response of MAP to ganglionic blockade with hexamethonium in conscious rats was performed to evaluate sympathetic activity. The renal sympathetic nerve activity and cardiac sympathetic afferent reflex were enhanced in adriamycin rats and the maximum depres- sor response of MAP induced by hexamethonium was significantly greater in adriamycin rats than that in control rats. Bilateral PVN microinjection of angiotensin II （Ang II） caused larger responses of the cardiac sympathetic afferent reflex, baseline renal sympathetic nerve activity and MAP in adriamycin rats than control rats. These re- sults indicated that both sympathetic activity and cardiac sympathetic afferent reflex were enhanced and Ang II in the PVN was involved in the enhanced sympathetic activity and cardiac sympathetic afferent reflex in rats with adriamycin-induced heart failure.展开更多
Sympathetic activation and the kidney play critical roles in hypertension and chronic heart failure.The role of the kidney in sympathetic activation is still not well known.In this study,we revealed an excitatory rena...Sympathetic activation and the kidney play critical roles in hypertension and chronic heart failure.The role of the kidney in sympathetic activation is still not well known.In this study,we revealed an excitatory renal reflex(ERR)in rats induced by chemical stimulation of the kidney that regulated sympathetic activity and blood pressure.The ERR was induced by renal infusion of capsaicin,and evaluated by the changes in renal sympathetic outflow,blood pressure,and heart rate.Renal infusion of capsaicin dose-dependently increased the contralateral renal sympathetic nerve activity,mean arterial pressure,and heart rate.Capsaicin in the corticomedullary border had greater effects than in the cortex or medulla.Intravenous infusion of capsaicin had no significant effects.The effects of renal infusion of capsaicin were abolished by ipsilateral renal denervation,but were not affected by bilateral sinoaortic denervation.Renal infusion of capsaicin increased the ipsilateral renal afferent activity.The ERR was also induced by renal infusion of bradykinin,adenosine,and angiotensin II,but not by ATP.Renal infusion of capsaicin increased c-Fos expression in the paraventricular nucleus(PVN)of hypothalamus.Lesion of neurons in the PVN with kainic acid abolished the capsaicin-induced ERR.These findings indicate that chemical stimulation of kidney causes an excitatory reflex,leading to sympathetic activation,pressor response,and accelerated heart rate.The PVN is an important central nucleus in the pathway of the ERR.展开更多
Renal denervation is a new technique approved effective for resistant-hypertension treatment.The common renal denervation system consists of a generator and a flexible catheter.During this minimally invasive procedure...Renal denervation is a new technique approved effective for resistant-hypertension treatment.The common renal denervation system consists of a generator and a flexible catheter.During this minimally invasive procedure,the interventionalist uses a steerable catheter with a radio frequency(RF)energy electrode tip.The RF energy is delivered to the renal artery via standard femoral artery access.A series of 2-minute ablation are delivered in each renal artery to distroy the nerves system.The procedure does not involve a permanent device implant.By deactivating the renal nerves,and therefore reducing sympathetic nerve transmission,a significant and reliable reduction in blood pressure could be achieved.In this review,potential complications and future sights of renal denervation are also discussed.展开更多
Previous studies have shown that sympathetic nerves are related to certain types of pain, and this phenomenon is referred to as sympathetic-sensory coupling. Chronic pain resulting from nerve injury can be exacerbated...Previous studies have shown that sympathetic nerves are related to certain types of pain, and this phenomenon is referred to as sympathetic-sensory coupling. Chronic pain resulting from nerve injury can be exacerbated by sympathetic stimulation or relieved by sympathetic inhibition. In the present study, the correlation between pain and sympathetic nerves was analyzed in patients with severe pain in lower limbs, as we^l as in a chronically compressed dorsa~ root ganglion ~CCD） rat model （model of low back pain and sciatica）. Patients with severe pain in the lower limbs underwent chemical lumbar sympathectomy （CLS）, and the analgesic effects of CLS were compared with painkillers. Results demonstrated significantly relieved lower limb pain following CLS, and the analgesic effects of CLS were superior to those seen with painkillers. In the CCD rat model, dorsal root ganglion neuronal activity significantly increased as a result of electrical stimulation to the sympathetic nerves. These results suggest that sympathetic nerves are closely associated with pain and sympathetic-sensory coupling is likely in lower limb pain in both patients and rat models of CCD.展开更多
文摘目的:观察12周有氧运动对慢性心力衰竭大鼠心功能、交感神经活性和运动能力的影响并探索其可能机制。方法:Wistar大鼠通过结扎冠状动脉建立心梗后心衰模型,术后4周后随机分为假手术安静组(SH组)、心梗安静组(MI组)和心梗运动组(MI-Ex组),MI-Ex组进行12周跑台运动,SH组和MI组保持安静状态。12周结束后,利用递增负荷跑台实验测定运动能力,包括力竭时间、力竭距离和最大跑速;超声心动图检测心脏结构与功能,包括左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、缩短分数(FS)、左室射血分数(LVEF)和心率(HR);高压液相色谱法测定心肌和血浆去甲肾上腺素(NE)水平;RT-PCR和Western Blot法检测心肌β1肾上腺素能受体(β1-AR)、G蛋白偶联受体激酶2(GRK2)和酪氨酸羟化酶(TH)基因和蛋白表达水平。结果:与SH组比较,MI组力竭时间、力竭距离和最大跑速均显著性降低(P<0.01);BW、FS和LVEF下降(P<0.01),HW、HW/BW、LVESD、LVEDD和HR升高(P<0.01);血浆NE升高,心肌NE降低(P<0.01);心肌β1-AR、TH m RNA和蛋白水平降低(P<0.01),GRK2 m RNA和蛋白水平升高(P<0.01)。与MI组比较,MI-Ex组力竭时间、力竭距离和最大跑速均显著性升高(P<0.01),LVESD和LVEDD降低(P<0.01),FS和LVEF升高(P<0.01);血浆NE降低,心肌NE升高(P<0.01);心肌β1-AR、TH m RNA和蛋白水平升高(P<0.01),GRK2 m RNA和蛋白水平降低(P<0.01)。结论:长期有氧运动增强慢性心衰大鼠心脏交感活性并改善心功能和运动能力,其机制可能与心肌GRK2表达下调以及β1-AR表达上调有关。
文摘Background Increased renal sympathetic nerve activity can result in diuretic resistance in patients with chronic congestive heart failure. We investigated the effect of regional renal nerve blockade on the patients with chronic refractory heart failure and diuretic resistance. Methods Eighteen patients with chronic refractory heart failure were enrolled （mean age （64＋11） years）. The patients were randomly divided into two groups （renal nerve blockade group and standard therapy group, n=9 each）. Renal nerve blockade was performed by percutaneous injection of local anaesthetic under computed tomographic guidance. Heart rate, mean arterial blood pressure, plasma and urine electrolytes, neurohormones, factional excretion of sodium （FENa）, 24-hour urine volume were monitored at baseline and the first 24 hours after therapy. Dyspnea and oedema were also evaluated. The major adverse cardiovascular events （MACE）, plasma brain natriuretic peptide （BNP） level and left ventricular ejection fraction （LVEF） were compared between the two groups during the 3-12 months follow-up period. Results No complication was observed during the acute phase of renal nerve blockade. After renal nerve blockade, the 24-hour urine volume and FENa were significantly increased, while the level of plasma rennin, angiotensin II, aldosterone BNP and atrial natriuretic peptide as well as dyspnea and oedema were significantly reduced in renal nerve blockade group compared with baseline and standard therapy group. During three to 12 months of follow-up, the rate of MACE and plasma BNP level were significantly lower, while LVEF was significantly higher in renal nerve blockade group than those in standard therapy group. Conclusion Regional renal nerve blockade may be a safe and effective treatment for patients with chronic refractory heart failure.
基金supported by research grants to VJT from the National Institutes of Health(R01 NS085426)the Department of Defense(W81XWH-14-1-060)
文摘Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury（SCI）. Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics due to deregulated sympathetic outflow. As a result of the reduced sympathetic activity, patients with SCI may experience hypotension, cardiac dysrhythmias, and hypothermia post-injury. In the chronic phase, changes within the CNS and blood vessels lead to orthostatic hypotension and life-threatening autonomic dysreflexia（AD）. AD is characterized by an episodic, massive sympathetic discharge that causes severe hypertension associated with bradycardia. The syndrome is often triggered by unpleasant visceral or sensory stimuli below the injury level. Currently the only treatments are palliative - once a stimulus elicits AD, pharmacological vasodilators are administered to help reduce the spike in arterial blood pressure. However, a more effective means would be to mitigate AD development by attenuating contributing mechanisms, such as the reorganization of intraspinal circuits below the level of injury. A better understanding of the neuropathophysiology underlying cardiovascular dysfunction after SCI is essential to better develop novel therapeutic approaches to restore hemodynamic performance.
文摘Most cases of sudden cardiac death are attributed to sustained ventricular tachyarrhythmias(VTs), triggered by acute coronary occlusion. Autonomic dysfunction, an important arrhythmogenic mechanism in this setting, is being actively investigated, aiming at the advent of preventive strategies. Recent experimental studies have shown vagal withdrawal after anterior myocardial infarction, coinciding with high incidence of VTs, followed by more gradual sympathetic activation coinciding with a second arrhythmia peak. This article summarizes recent knowledge on this intriguing topic, generating hypotheses that can be investigated in future experimental and clinical studies.
文摘Resistant hypertension remains a major clinical problem despite the available multidrug therapy.Over the next decades,its incidence will likely increase given that it is strongly associated with older age and obesity.Resistant hypertension patients have an increased cardiovascular risk,thus effective antihypertensive treatment will provide substantial health benefits.The crosstalk between sympathetic nervous system and kidneys plays a crucial role in hypertension.It influences several pathophysiological mechanisms such as the central sympathetic tone,the sodium balance and the systemic neurohumoral activation.In fact,studies using several animal models demonstrated that the renal denervation prevented and attenuated hypertension in multiple species.Large reductions in blood pressure were also observed in malignant hypertension patients submitted to sympathectomy surgeries.However,these approaches had an unacceptably high rates of periprocedural complications and disabling adverse events.Recently,an innovative non-pharmacological therapy that modulates sympathetic activation has been successfully developed.Renal sympathetic percutaneous denervation is an endovascular procedure that uses radiofrequency energy to destroy the autonomic renal nerves running inside the adventitia of renal arteries.This method represents a promising new approach to the strategy of inhibiting the sympathetic nervous system.The aim of this review is to examine the background knowledge that resulted in the development of this hypertension treatment and to critically appraise the available clinical evidence.
文摘Neuropathic pain and the other abnormalities of sensation induced by axon injury or by peripheral nerve inflammation should result from functional compensations of the injured neurons during their regeneration. Ectopic distribution of proteins related to Na+, K+ and Ca2+ channels as well as of receptors on both membranes of injured axon and its cell body becomes a main pacemaker from which spontaneous ectopic afferent of primary sensatory neurons and crosstalk between neurons occur. Abnormal ectopic afferent activities lead to disorders of the sensation, such as hyperalgesia, allodynia, spontaneous pain and paraesthesia. Administration of some ion channel agents and/or α2-adrenergic blockers has shown efficiency in preventing neuropathic pain development and in relieving neuropathic pain.
文摘目的观察艾贝宁对神经源性肺水肿交感活性亢进的抑制作用。方法 97例神经源性肺水肿患者分对照组(C)、倍他乐克组(M)、艾贝宁组(D),测定血浆去甲肾上腺素(NE)、肾上腺素(E)评估交感活性,血浆脑型利钠肽(BNP)并行心脏超声等评估心功能状态,记录呼吸机参数评估呼吸机支持力度。结果与其他组相比,D组血浆NE(4.51±0.24 vs 3.98±0.49 vs 3.61±0.31,P<0.05)、E(3.23±0.51 vs 3.01±0.67 vs 2.19±0.29,P<0.05),交感活性明显受抑,BNP(4783.59±179.33 vs 3584.26±164.71 vs 3126.88±158.72,P<0.05),左室射血分数显著提高(LVEF:47.49%±1.29%vs 53.22%±2.13%vs 58.91%±2.04%,P<0.05)心功能改善。机械通气时间缩短(P<0.05),呼吸机支持力度下降(P<0.05),肺功能好转。结论艾贝宁可有效抑制神经源性肺水肿患者交感活性亢进,改善心肺功能。
文摘Greater fluctuations in office blood pressure increase the risk of stroke and blood pressure volatility is an important risk factor for cardiovascular events. Effects of sympathetic and parasympathetic nerve on blood pressure regulation are well known, however, those on visit-to visit variation remains unclear. Aim of this study is to clarify the contribution of sympathetic and parasympathetic balance on blood pressure fluctuation. Methods: We enrolled 23 outpatients with essential hypertension. We measured blood pressure, and pulse rate at clinic 14 times in a row and calculated coefficient of variance (CV) as visit-to-visit variability. The velocity of pupil contraction, miosis (VC) and dilation, mydriasis (VD) was determined from pupillary function test. Results: Systolic blood pressure and diastolic blood pressure were not significantly correlated with VC, VD and VD/VC. Heart rate was not correlated with VC and VD, but significantly correlated with VD/VC. CV of systolic blood pressure, diastolic blood pressure and heart rate were not significantly correlated with VC or VD. Ratio of VD to VC significantly negative correlated with CV of blood pressure, diastolic blood pressure, and heart. Value of VD was significantly correlated with value of VC. Conclusion: Visit-to-visit variability of blood pressure and heart rate is not related with sympathetic or parasympathetic tone independently but augmented by the impaired sympathetic and parasympathetic balance.
基金Supported by National Natural Science Foundation of China, No. 39970242
文摘Objective: To study sympathetic-sensory coupling in chronically compressed dorsal root ganglion (DRG) neurons in rats. Methods: In chronically compressed DRG model, the spontaneous activity of single fiber from the injured DRG neuron was recorded, and lumbar sympathetic trunk was electrical stimulated to study the sympathetic modulation of spontaneous activities in injured DRG neurons. Results: Fifty-seven percent of spontaneous active neurons of injured DRG responded to sympathetic stimulation. The responses included simple excitation, excitation followed by inhibition and simple inhibition. The responses enhanced with the increase of sympathetic stimulation time. The responses to sympathetic stimula- tion could be blocked by intravenously injection of phentolamine, a-adrenorecepor antagonist. Fifty-three percent of injured DRG responded to norepinephrine (NE). The responses to NE were similar to those induced by sympathetic stimulation. Conclusion: Sympathetic-sensory coupling is virtually present in chronic compressed DRG neurons. NE released from sympathetic nerve terminals acts on a-adrenorecepor to influence spontaneous activities of injured DRG neurons.
基金supported by the Natural Science Fund of Nanjing Medical University (No. 2010NJMUZ23)Natural Science Fund of Jiangsu Provincial Department of Education (No. 11KJB310002 &10KJB310004)Chinese National Natural Science Fund (No.81100182)
文摘Our previous studies have shown that the cardiac sympathetic afferent reflex is enhanced in rats with chronic heart failure （CHF） induced by coronary artery ligation and contributes to the over-excitation of sympathetic ac- tivity. We sought to determine whether sympathetic activity and cardiac sympathetic afferent reflex were en- hanced in adriamycin-induced CHF and whether angiotensin II （Ang II） in the paraventricular nucleus （PVN） was involved in enhancing sympathetic activity and cardiac sympathetic afferent reflex. Heart failure was induced by intraperitoneal injection of adriamycin for six times during 2 weeks （15 mg/kg）. Six weeks after the first injec- tion, the rats underwent anesthesia with urethane and a-chloralose. After vagotomy and baroreceptor denervation, cardiac sympathetic afferent reflex was evaluated by renal sympathetic nerve activity and mean arterial pressure （MAP） response to epicardial application of capsaicin （1.0 nmol）. The response of MAP to ganglionic blockade with hexamethonium in conscious rats was performed to evaluate sympathetic activity. The renal sympathetic nerve activity and cardiac sympathetic afferent reflex were enhanced in adriamycin rats and the maximum depres- sor response of MAP induced by hexamethonium was significantly greater in adriamycin rats than that in control rats. Bilateral PVN microinjection of angiotensin II （Ang II） caused larger responses of the cardiac sympathetic afferent reflex, baseline renal sympathetic nerve activity and MAP in adriamycin rats than control rats. These re- sults indicated that both sympathetic activity and cardiac sympathetic afferent reflex were enhanced and Ang II in the PVN was involved in the enhanced sympathetic activity and cardiac sympathetic afferent reflex in rats with adriamycin-induced heart failure.
基金supported by the National Natural Science Foundation of China(31871148,91639105,31571167,and 31571168).
文摘Sympathetic activation and the kidney play critical roles in hypertension and chronic heart failure.The role of the kidney in sympathetic activation is still not well known.In this study,we revealed an excitatory renal reflex(ERR)in rats induced by chemical stimulation of the kidney that regulated sympathetic activity and blood pressure.The ERR was induced by renal infusion of capsaicin,and evaluated by the changes in renal sympathetic outflow,blood pressure,and heart rate.Renal infusion of capsaicin dose-dependently increased the contralateral renal sympathetic nerve activity,mean arterial pressure,and heart rate.Capsaicin in the corticomedullary border had greater effects than in the cortex or medulla.Intravenous infusion of capsaicin had no significant effects.The effects of renal infusion of capsaicin were abolished by ipsilateral renal denervation,but were not affected by bilateral sinoaortic denervation.Renal infusion of capsaicin increased the ipsilateral renal afferent activity.The ERR was also induced by renal infusion of bradykinin,adenosine,and angiotensin II,but not by ATP.Renal infusion of capsaicin increased c-Fos expression in the paraventricular nucleus(PVN)of hypothalamus.Lesion of neurons in the PVN with kainic acid abolished the capsaicin-induced ERR.These findings indicate that chemical stimulation of kidney causes an excitatory reflex,leading to sympathetic activation,pressor response,and accelerated heart rate.The PVN is an important central nucleus in the pathway of the ERR.
文摘Renal denervation is a new technique approved effective for resistant-hypertension treatment.The common renal denervation system consists of a generator and a flexible catheter.During this minimally invasive procedure,the interventionalist uses a steerable catheter with a radio frequency(RF)energy electrode tip.The RF energy is delivered to the renal artery via standard femoral artery access.A series of 2-minute ablation are delivered in each renal artery to distroy the nerves system.The procedure does not involve a permanent device implant.By deactivating the renal nerves,and therefore reducing sympathetic nerve transmission,a significant and reliable reduction in blood pressure could be achieved.In this review,potential complications and future sights of renal denervation are also discussed.
基金the Natural Science Foundation of Guangdong Province,No. 05300503
文摘Previous studies have shown that sympathetic nerves are related to certain types of pain, and this phenomenon is referred to as sympathetic-sensory coupling. Chronic pain resulting from nerve injury can be exacerbated by sympathetic stimulation or relieved by sympathetic inhibition. In the present study, the correlation between pain and sympathetic nerves was analyzed in patients with severe pain in lower limbs, as we^l as in a chronically compressed dorsa~ root ganglion ~CCD） rat model （model of low back pain and sciatica）. Patients with severe pain in the lower limbs underwent chemical lumbar sympathectomy （CLS）, and the analgesic effects of CLS were compared with painkillers. Results demonstrated significantly relieved lower limb pain following CLS, and the analgesic effects of CLS were superior to those seen with painkillers. In the CCD rat model, dorsal root ganglion neuronal activity significantly increased as a result of electrical stimulation to the sympathetic nerves. These results suggest that sympathetic nerves are closely associated with pain and sympathetic-sensory coupling is likely in lower limb pain in both patients and rat models of CCD.
