Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
Compr Physiol. 2013 Oct;3(4):1569-610. doi: 10.1002/cphy.c130006.
This review presents concepts of scientific integrative medicine and relates them to the physiology of catecholamine systems and to the pathophysiology of catecholamine-related disorders. The applications to catecholamine systems exemplify how scientific integrative medicine links systems biology with integrative physiology. Concepts of scientific integrative medicine include (i) negative feedback regulation, maintaining stability of the body's monitored variables; (ii) homeostats, which compare information about monitored variables with algorithms for responding; (iii) multiple effectors, enabling compensatory activation of alternative effectors and primitive specificity of stress response patterns; (iv) effector sharing, accounting for interactions among homeostats and phenomena such as hyperglycemia attending gastrointestinal bleeding and hyponatremia attending congestive heart failure; (v) stress, applying a definition as a state rather than as an environmental stimulus or stereotyped response; (vi) distress, using a noncircular definition that does not presume pathology; (vii) allostasis, corresponding to adaptive plasticity of feedback-regulated systems; and (viii) allostatic load, explaining chronic degenerative diseases in terms of effects of cumulative wear and tear. From computer models one can predict mathematically the effects of stress and allostatic load on the transition from wellness to symptomatic disease. The review describes acute and chronic clinical disorders involving catecholamine systems-especially Parkinson disease-and how these concepts relate to pathophysiology, early detection, and treatment and prevention strategies in the post-genome era.
这篇综述介绍了科学整合医学的概念，并将其与儿茶酚胺系统的生理学和儿茶酚胺相关疾病的病理生理学联系起来。儿茶酚胺系统的应用示例说明了科学整合医学如何将系统生物学与整合生理学联系起来。科学整合医学的概念包括：（i）负反馈调节，维持身体监测变量的稳定性；（ii）稳态，将监测变量的信息与响应算法进行比较；（iii）多种效应器，使替代效应器的代偿性激活和应激反应模式的原始特异性成为可能；（iv）效应器共享，解释稳态之间的相互作用以及诸如胃肠道出血时的高血糖和充血性心力衰竭时的低钠血症等现象；（v）应激，将其定义为一种状态，而不是环境刺激或刻板反应；（vi）痛苦，使用一种非循环的定义，不假定病理学；（vii）适应，对应于反馈调节系统的适应性可塑性；（viii）适应负荷，根据累积磨损的影响来解释慢性退行性疾病。从计算机模型中，人们可以预测应激和适应负荷对从健康到有症状疾病的转变的影响。该综述描述了涉及儿茶酚胺系统的急性和慢性临床疾病，特别是帕金森病，以及这些概念如何与病理生理学、早期检测以及在后基因组时代的治疗和预防策略相关。
