Onodera S
First Department of Internal Medicine, Asahikawa Medical College, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Dec;30 Suppl:15-25.
Alterations in the physiological balance to maintain the pulmonary circulation at a normal low pressure level result in an elevation in pulmonary vascular tone. Pulmonary vasoconstrictor responses were analyzed under some experimental conditions, which included microembolism, administration of vasoactive agents, hypoxia, and monocrotaline-induced pulmonary hypertension. It is widely accepted that these responses are highly localized and complex. In the present study, excised canine lung lobes, rat lungs, and pulmonary arterial rings from the rat were employed according to the particular experimental design. The mechanism of the initial rapid elevation followed by a gradual decline in perfusion pressure in microembolism was considered to be related not only to the size of the emboli, but to the degree of mechanical injury of the endothelium. The main sites of constriction of the pulmonary vasculature by several drugs were determined in the pulsatile perfused canine lung lobes, according to the degree of decrease in inflow wave amplitude during antegrade or retrograde perfusion. Further, by applying the same method it was confirmed that the site of hypoxic vasoconstriction is located in the peripheral pulmonary vascular bed between the muscular arteries and veins, which are constricted mainly by serotonin and histamine, respectively. A cross perfusion system was set up, employing two lobes from the same dog, in which normoxic blood was perfused into the hypoxic ventilated lobe and vice versa. As a result, the pulmonary vessels showed a response to ventilation hypoxia that was far more sensitive than that to perfusion hypoxia. The effects of a beta-agonist (isoproterenol) and beta-antagonists (propranolol, pindolol) on hypoxic vasoconstriction were observed. Although pindolol (a vasodilatory beta-blocker) abolished hypoxic pulmonary vasoconstriction, which was similar to the effect of isoproterenol, the mechanism of action of pindolol was suggested to be different from that of isoproterenol. The importance of the K+ channel of vascular smooth muscle and also the endothelium in hypoxic pulmonary vasoconstriction were stressed. In isolated pulmonary artery segments of the monocrotaline-treated rat, the augmentation of sensitivity of the vascular smooth muscle to Ca2+ preceded the occurrence of pulmonary hypertension. Similarly, hyperreactivity to KCl and serotonin was also observed. It was clarified that the hyperreactivity induced by monocrotaline is modified by endothelium-dependent relaxation. Extensive cellular and molecular biological investigations are essential for further progress in this field.
为维持肺循环处于正常低压水平而发生的生理平衡改变会导致肺血管张力升高。在一些实验条件下分析了肺血管收缩反应,这些条件包括微栓塞、血管活性药物给药、缺氧以及野百合碱诱导的肺动脉高压。人们普遍认为这些反应具有高度的局部性和复杂性。在本研究中,根据特定的实验设计使用了切除的犬肺叶、大鼠肺以及大鼠的肺动脉环。微栓塞时灌注压最初迅速升高随后逐渐下降的机制被认为不仅与栓子大小有关,还与内皮的机械损伤程度有关。根据顺行或逆行灌注期间流入波幅度的降低程度,在搏动灌注的犬肺叶中确定了几种药物对肺血管系统的主要收缩部位。此外,通过应用相同方法证实,缺氧性血管收缩部位位于肌性动脉和静脉之间的外周肺血管床,肌性动脉和静脉分别主要由5-羟色胺和组胺收缩。建立了一个交叉灌注系统,使用同一只狗的两个肺叶,其中将常氧血液灌注到缺氧通气的肺叶中,反之亦然。结果,肺血管对通气性缺氧的反应比对灌注性缺氧的反应敏感得多。观察了β激动剂(异丙肾上腺素)和β拮抗剂(普萘洛尔、吲哚洛尔)对缺氧性血管收缩的影响。尽管吲哚洛尔(一种血管舒张性β阻滞剂)消除了缺氧性肺血管收缩,这与异丙肾上腺素的作用相似,但吲哚洛尔的作用机制被认为与异丙肾上腺素不同。强调了血管平滑肌以及内皮的钾通道在缺氧性肺血管收缩中的重要性。在野百合碱处理的大鼠的离体肺动脉段中,血管平滑肌对钙离子敏感性的增强先于肺动脉高压的发生。同样地,也观察到对氯化钾和5-羟色胺的反应性增强。明确了野百合碱诱导的反应性增强可被内皮依赖性舒张所改变。广泛的细胞和分子生物学研究对于该领域的进一步进展至关重要。