Ferguson D W, Berg W J, Sanders J S
Department of Internal Medicine, University of Iowa Hospitals, Iowa City 52247.
J Am Coll Cardiol. 1990 Nov;16(5):1125-34. doi: 10.1016/0735-1097(90)90544-y.
To characterize the neural excitatory state of heart failure, simultaneous measurements of efferent sympathetic nerve activity to muscle (by microneurography) and rest hemodynamics were obtained in 10 normal subjects (age 25 +/- 2 years, mean +/- SEM) and 29 patients with heart failure (age 49 +/- 2 years; New York Heart Association functional class II to IV; left ventricular ejection fraction 21 +/- 1%; cardiac index = 2.16 +/- 0.13 liters/min per m2; pulmonary capillary wedge pressure 23 +/- 2 mm Hg). Sympathetic nerve activity was significantly higher in the patients with heart failure (54.7 +/- 4.5 bursts/min) than in normal subjects (16.7 +/- 2.2 bursts/min, p less than 0.001). Multiple linear regression analyses indicated that sympathetic activity in these human subjects was most strongly and inversely correlated with left ventricular stroke work index (r = -0.86, p less than 0.0001) and stroke volume index (r = -0.85, p less than 0.0001). There was a strong positive correlation between sympathetic nerve activity and pulmonary artery diastolic (r = 0.82, p less than 0.0001) and mean (r = 0.81, p less than 0.0001) pressures. Similar correlations were seen when patients with heart failure were analyzed separately. There was no significant correlation between sympathetic nerve activity and mean arterial pressure, left ventricular ejection fraction (by radionuclide ventriculography), cardiac chamber size (by echocardiography) or arterial oxygen tension in the patients with heart failure. Direct measurements of sympathetic nerve activity correlated closely with plasma norepinephrine (r = 0.72, p less than 0.0001) in patients with heart failure. Thus, sympathetic nerve activity at rest parallels impairment of cardiac performance in patients with heart failure.
为了描述心力衰竭时的神经兴奋状态，我们对10名正常受试者（年龄25±2岁，均值±标准误）和29名心力衰竭患者（年龄49±2岁；纽约心脏协会心功能分级II至IV级；左心室射血分数21±1%；心脏指数=2.16±0.13升/分钟每平方米；肺毛细血管楔压23±2毫米汞柱）同时进行了对肌肉的传出交感神经活动（通过微神经ography）和静息血流动力学测量。心力衰竭患者的交感神经活动（54.7±4.5次爆发/分钟）显著高于正常受试者（16.7±2.2次爆发/分钟，p<0.001）。多元线性回归分析表明，这些人类受试者的交感神经活动与左心室每搏功指数（r=-0.86，p<0.0001）和每搏量指数（r=-0.85，p<0.0001）呈最强的负相关。交感神经活动与肺动脉舒张压（r=0.82，p<0.0001）和平均压（r=0.81，p<0.0001）之间存在强正相关。单独分析心力衰竭患者时也观察到类似的相关性。心力衰竭患者的交感神经活动与平均动脉压、左心室射血分数（通过放射性核素心室造影）、心腔大小（通过超声心动图）或动脉血氧张力之间无显著相关性。心力衰竭患者的交感神经活动直接测量值与血浆去甲肾上腺素密切相关（r=0.72，p<0.0001）。因此，心力衰竭患者静息时的交感神经活动与心脏功能损害平行。
