Heusch G
Department of Pathophysiology, University of Essen Medical School, FRG.
Circulation. 1990 Jan;81(1):1-13. doi: 10.1161/01.cir.81.1.1.
alpha-Adrenoceptor-mediated effects of sympathetic activation on the heart and coronary circulation are reviewed with emphasis on the pathophysiology of myocardial ischemia. A classification of alpha-adrenoceptor subtypes is presented, and the effects of alpha-adrenoceptor activation on presynaptic sympathetic nerve terminals, cardiomyocytes, endothelium, platelets, and coronary smooth muscle cells are discussed. alpha-Adrenergic coronary vasoconstriction at rest and during situations of sympathetic activation such as exercise and excitement is analyzed for the segmental, transmural, and regional distribution of coronary blood flow. Evidence for a significant contribution of alpha-adrenergic coronary vasoconstriction to experimental and clinical myocardial ischemia is provided. Cardiomyocyte alpha-adrenoceptor activation may be involved in ischemic and reperfusion arrhythmias. The participation of presynaptic and postsynaptic alpha-adrenoceptors, as well as of alpha 1- and alpha 2-adrenoceptors, in experimental and clinical myocardial ischemia will require further investigation.
本文综述了交感神经激活通过α-肾上腺素能受体对心脏和冠状动脉循环的影响，重点关注心肌缺血的病理生理学。文中介绍了α-肾上腺素能受体亚型的分类，并讨论了α-肾上腺素能受体激活对突触前交感神经末梢、心肌细胞、内皮细胞、血小板和冠状动脉平滑肌细胞的影响。分析了静息状态以及运动和兴奋等交感神经激活情况下，α-肾上腺素能受体介导的冠状动脉血管收缩对冠状动脉血流节段、透壁和区域分布的影响。提供了证据表明α-肾上腺素能受体介导的冠状动脉血管收缩在实验性和临床心肌缺血中起重要作用。心肌细胞α-肾上腺素能受体激活可能与缺血性和再灌注性心律失常有关。突触前和突触后α-肾上腺素能受体以及α1和α2肾上腺素能受体在实验性和临床心肌缺血中的作用还有待进一步研究。
