Anderson F L, Port J D, Reid B B, Hanson G, Kralios A C, Hershberger R E, Bristow M R
Department of Medicine (Cardiology), University of Utah School of Medicine, Salt Lake City.
J Cardiovasc Pharmacol. 1992;20(5):800-6.
The purpose of this study was to investigate the relationship between dopamine (DA) exposure and myocardial catecholamine and neuropeptide Y (NPY) concentrations in patients with severe congestive heart failure due to idiopathic dilated cardiomyopathy (IDC). Both nonfailing (NF) and failing (F) hearts were obtained in collaboration with the Utah Cardiac Transplantation Program and the Intermountain Organ Recovery System. The patients were stratified into five groups according to their preoperative exposure to dobutamine (DBT) and/or DA. Compared to 12 untreated, NF control hearts, norepinephrine (NE) concentrations were significantly decreased in 30 untreated F hearts obtained from patients with IDC. Norepinephrine concentrations were also significantly decreased in DA-treated NF hearts and in DA-treated F hearts compared to untreated NF and untreated or DBT-treated failing hearts, respectively. NPY concentrations were significantly decreased in untreated F hearts and were further decreased in dopamine-treated NF and DA-treated F hearts compared to untreated NF and untreated or DBT-treated F hearts. Thus, NE and NPY depletion related to DA administration was evident in both NF and F myocardium and was specific for DA in that it was not evident in patients who received the direct-acting beta-agonist inotrope DBT. These data suggest that the major inotropic mechanism of action of DA is through cardiac adrenergic neurotransmitter release. The data also provide further support for the concept that indirect acting inotropes such as DA may have limited inotropic potential in F hearts where neuronal NE has been depleted.
本研究的目的是调查因特发性扩张型心肌病（IDC）导致的严重充血性心力衰竭患者中多巴胺（DA）暴露与心肌儿茶酚胺及神经肽Y（NPY）浓度之间的关系。非衰竭（NF）心脏和衰竭（F）心脏均是与犹他心脏移植项目及山间器官回收系统合作获取的。根据患者术前使用多巴酚丁胺（DBT）和/或DA的情况，将患者分为五组。与12个未经治疗的NF对照心脏相比，从IDC患者获取的30个未经治疗的F心脏中去甲肾上腺素（NE）浓度显著降低。与未经治疗的NF心脏以及未经治疗或接受DBT治疗的衰竭心脏相比，DA治疗的NF心脏和DA治疗的F心脏中去甲肾上腺素浓度也显著降低。未经治疗的F心脏中NPY浓度显著降低，与未经治疗的NF心脏以及未经治疗或接受DBT治疗的F心脏相比，多巴胺治疗的NF心脏和DA治疗的F心脏中NPY浓度进一步降低。因此，在NF和F心肌中，与DA给药相关的NE和NPY耗竭均很明显，且对DA具有特异性，因为在接受直接作用的β激动剂强心剂DBT的患者中不明显。这些数据表明，DA的主要强心作用机制是通过心脏肾上腺素能神经递质释放。这些数据还进一步支持了这样一种概念，即像DA这样的间接作用强心剂在神经元NE已耗竭的F心脏中可能具有有限的强心潜力。
