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鼻黏膜血流和分泌的感觉与运动反射控制;非过敏性鼻高反应性的临床意义。

Sensory and motor reflex control of nasal mucosal blood flow and secretion; clinical implications in non-allergic nasal hyperreactivity.

作者信息

Stjärne P

机构信息

Department of Otorhinolaryngology, Karolinska Hospital, Stockholm, Sweden.

出版信息

Acta Physiol Scand Suppl. 1991;600:1-64.

PMID:1891972
Abstract
  1. Co-localization of SP and CGRP was observed in a dense intraepithelial and perivascular network of capsaicin-sensitive sensory nerves in the nasal mucosa of different species, including man. The morphological similarity in the distribution of these nerves among various experimental animals and man indicates that animal experimental data may be used for the understanding of sensory mechanisms in the human nasal mucosa. 2. Release of CGRP into the venous effluent of the nasal mucosa in parallel with vasodilatation was demonstrated in vivo upon antidromic stimulation of the maxillary division of the trigeminal nerve or local i.a. capsaicin injection. 3. Infusion of capsaicin induced concentration-dependent increase in arterial, venous and superficial blood flow as well as V in the pig nasal mucosa. Exogenous SP, CGRP and VIP displayed concentration-dependent, but partly separate, vasodilatory profiles in the nasal mucosa. SP was more potent regarding maximal blood flow increase, whereas the vasodilatation induced by CGRP infusion was more long-lasting on an equimolar basis. Although VIP caused an increase in ABF and VBF as well as V, the LDF signal (i.e. superficial blood flow) was decreased, possibly due to a stealing phenomenon. 4. Local i.a. capsaicin infusion induced a bilateral chlorisondamine-sensitive atropine-resistant vasodilatation. However, i.a. capsaicin in higher doses also induced a chlorisondamine-resistant vasodilatation in the superficial vascular compartment of the nasal mucosa, presumably via the release of sensory neuropeptides. Thus, the vasodilatory effect of capsaicin may be due to a complex interaction of local effects on the sensory nerve terminals close to blood vessels in the nasal mucosa and a main parasympathetic central reflex. 5. Capsaicin, but not nicotine, induced a concentration dependent increase in irritation or pain upon local application to the human nasal mucosa. Since both agents evoked secretion, this indicates that capsaicin and nicotine activate different populations of sensory neurons. Local application onto the nasal mucosa of capsaicin and nicotine as well as metacholine induced a concentration dependent muscarinic antagonist sensitive increase in the secretory response. The capsaicin or nicotine-induced secretion was bilateral and could be markedly reduced by combined pretreatment with a local anaesthetic and a vasoconstrictor. Our findings suggest that the secretory effect of capsaicin and nicotine in the human nasal mucosa is mediated via a central parasympathetic reflex arc with a final muscarinic receptor mechanism. No clear-cut contribution seemed to be exerted by locally released tachykinins and CGRP as direct trigger substances for the secretory response to capsaicin.(ABSTRACT TRUNCATED AT 400 WORDS)
摘要
  1. 在包括人类在内的不同物种的鼻黏膜中,P物质(SP)和降钙素基因相关肽(CGRP)在密集的上皮内和血管周围辣椒素敏感感觉神经网络中被观察到共定位。这些神经在各种实验动物和人类中的分布形态相似,表明动物实验数据可用于理解人类鼻黏膜的感觉机制。2. 在体内,通过三叉神经上颌支的逆向刺激或局部动脉内注射辣椒素,证实CGRP与血管舒张同时释放到鼻黏膜的静脉流出物中。3. 辣椒素注入可引起猪鼻黏膜动脉、静脉和浅表血流以及鼻腔容积(V)的浓度依赖性增加。外源性SP、CGRP和血管活性肠肽(VIP)在鼻黏膜中呈现浓度依赖性但部分分离的血管舒张曲线。就最大血流增加而言,SP更有效,而等摩尔浓度的CGRP注入所诱导的血管舒张更持久。尽管VIP引起了动脉血流量(ABF)、静脉血流量(VBF)以及V的增加,但激光多普勒血流仪信号(即浅表血流)却降低了,这可能是由于一种窃血现象。4. 局部动脉内注入辣椒素可引起双侧对氯异苯胍敏感、阿托品抵抗的血管舒张。然而,高剂量的动脉内辣椒素也可在鼻黏膜浅表血管区诱导对氯异苯胍抵抗的血管舒张,推测是通过感觉神经肽的释放。因此,辣椒素的血管舒张作用可能是由于其对鼻黏膜血管附近感觉神经末梢的局部作用与主要的副交感中枢反射之间的复杂相互作用。5. 辣椒素而非尼古丁局部应用于人类鼻黏膜时,可引起刺激或疼痛的浓度依赖性增加。由于两种药物都能诱发分泌,这表明辣椒素和尼古丁激活了不同群体的感觉神经元。辣椒素、尼古丁以及乙酰甲胆碱局部应用于鼻黏膜可引起浓度依赖性的毒蕈碱拮抗剂敏感的分泌反应增加。辣椒素或尼古丁诱导的分泌是双侧性的,并且可通过局部麻醉剂和血管收缩剂联合预处理而显著减少。我们的研究结果表明,辣椒素和尼古丁在人类鼻黏膜中的分泌作用是通过具有最终毒蕈碱受体机制的中枢副交感反射弧介导的。局部释放的速激肽和CGRP似乎并未作为辣椒素分泌反应的直接触发物质发挥明显作用。(摘要截选至400字)

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