Yeoh Melanie, McLachlan Elspeth M, Brock James A
Prince of Wales Medical Research Institute, Randwick, NSW 2031, Australia.
J Physiol. 2004 Apr 15;556(Pt 2):545-55. doi: 10.1113/jphysiol.2003.056424. Epub 2004 Feb 6.
Patients with severe spinal cord lesions that damage descending autonomic pathways generally have low resting arterial pressure but bladder or colon distension or unheeded injuries may elicit a life-threatening hypertensive episode. Such episodes (known as autonomic dysreflexia) are thought to result from the loss of descending baroreflex inhibition and/or plasticity within the spinal cord. However, it is not clear whether changes in the periphery contribute to the exaggerated reflex vasoconstriction. The effects of spinal transection at T7-8 on nerve- and agonist-evoked contractions of the rat tail artery were investigated in vitro. Isometric contractions of arterial segments were recorded and responses of arteries from spinalized animals ('spinalized arteries') and age-matched and sham-operated controls were compared. Two and eight weeks after transection, nerve stimulation at 0.1-10 Hz produced contractions of greater force and duration in spinalized arteries. At both stages, the alpha-adrenoceptor antagonists prazosin (10 nm) and idazoxan (0.1 microm) produced less blockade of nerve-evoked contraction in spinalized arteries. Two weeks after transection, spinalized arteries were supersensitive to the alpha(1)-adrenoceptor agonist phenylephrine, and the alpha(2)-adrenoceptor agonist, clonidine, but 8 weeks after transection, spinalized arteries were supersensitive only to clonidine. Contractions of spinalized arteries elicited by 60 mm K(+) were larger and decayed more slowly at both stages. These findings demonstrate that spinal transection markedly increases nerve-evoked contractions and this can, in part, be accounted for by increased reactivity of the vascular smooth muscle to vasoconstrictor agents. This hyper-reactivity may contribute to the genesis of autonomic dysreflexia in patients.
严重脊髓损伤破坏下行自主神经通路的患者通常静息动脉压较低,但膀胱或结肠扩张或未被注意的损伤可能引发危及生命的高血压发作。这种发作(称为自主神经反射异常)被认为是由于脊髓内下行压力反射抑制和/或可塑性丧失所致。然而,尚不清楚外周变化是否导致过度的反射性血管收缩。在体外研究了T7-8水平脊髓横断对大鼠尾动脉神经和激动剂诱发收缩的影响。记录动脉节段的等长收缩,并比较脊髓损伤动物(“脊髓损伤动脉”)与年龄匹配的假手术对照组动脉的反应。横断后2周和8周,0.1-10Hz的神经刺激在脊髓损伤动脉中产生更大力量和持续时间的收缩。在两个阶段,α-肾上腺素能受体拮抗剂哌唑嗪(10nm)和咪唑克生(0.1μm)对脊髓损伤动脉中神经诱发收缩的阻断作用较小。横断后2周,脊髓损伤动脉对α1-肾上腺素能受体激动剂去氧肾上腺素和α2-肾上腺素能受体激动剂可乐定超敏,但横断后8周,脊髓损伤动脉仅对可乐定超敏。60mmol/L K+诱发的脊髓损伤动脉收缩在两个阶段都更大且衰减更慢。这些发现表明脊髓横断显著增加神经诱发的收缩,这部分可归因于血管平滑肌对血管收缩剂反应性的增加。这种高反应性可能促成患者自主神经反射异常的发生。