Laboratorio de Neurobiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Alameda, 340, Santiago, Chile.
Curr Hypertens Rep. 2018 May 22;20(6):53. doi: 10.1007/s11906-018-0849-z.
An abnormal heightened carotid body (CB) chemoreflex, which produces autonomic dysfunction and sympathetic overactivation, is the common hallmark of obstructive sleep apnea (OSA), resistant hypertension, systolic heart failure (HF), and cardiometabolic diseases. Accordingly, it has been proposed that the elimination of the CB chemosensory input to the brainstem may reduce the autonomic and cardiorespiratory alterations in sympathetic-associated diseases in humans.
A growing body of evidence obtained in preclinical animal models support that an enhanced CB discharge produces sympathetic hyperactivity, baroreflex sensitivity and heart rate variability impairment, breathing instability, hypertension, and insulin resistance. The elimination CB chemosensory input reduces the sympathetic hyperactivity, the elevated arterial blood pressure in OSA and hypertensive models, abolishes breathing instability and improves animal survival in HF models, and restores insulin tolerance in metabolic models. These results highlight the role played by the enhanced CB drive in the progression of sympathetic-related diseases and support the proposal that the surgical ablation of the CB is useful to restore the autonomic balance and normal cardiorespiratory function in humans. Accordingly, the CB ablation has been used in pilot human studies as a therapeutic treatment for resistant hypertension and HF-induced sympathetic hyperactivity. In this review, I will discuss the supporting evidence for a crucial contribution of the CB in the central autonomic dysfunction and the pros and cons of the CB ablation as a therapy to revert autonomic overactivation. The CB ablation could be a useful method to reverse the enhanced chemoreflex in HF and severe hypertension, but caution is required before extensive use of bilateral CB ablation, which abolished ventilatory responses to hypoxia and may impair baroreceptor function.
异常升高的颈动脉体（CB）化学感受器反射会导致自主神经功能障碍和交感神经过度兴奋，这是阻塞性睡眠呼吸暂停（OSA）、难治性高血压、收缩性心力衰竭（HF）和心脏代谢疾病的共同特征。因此，有人提出消除 CB 化学感受器传入脑干可能会减少与交感神经相关疾病中的自主神经和心肺改变。
越来越多的临床前动物模型证据表明，增强的 CB 放电会产生交感神经活性亢进、压力感受性反射敏感性和心率变异性受损、呼吸不稳定、高血压和胰岛素抵抗。消除 CB 化学感受器传入可降低交感神经活性亢进、OSA 和高血压模型中的动脉血压升高、消除呼吸不稳定并改善 HF 模型中的动物存活率，并恢复代谢模型中的胰岛素耐量。这些结果强调了增强的 CB 驱动在交感神经相关疾病进展中的作用，并支持了这样一种观点，即 CB 的手术消融有助于恢复人类的自主平衡和正常心肺功能。因此，CB 消融已被用于难治性高血压和 HF 引起的交感神经活性亢进的人类初步研究中作为一种治疗方法。在这篇综述中，我将讨论 CB 对中枢自主神经功能障碍的重要贡献的支持证据，以及 CB 消融作为逆转自主神经过度兴奋的治疗方法的利弊。CB 消融可能是逆转 HF 和严重高血压中增强的化学感受器反射的有用方法，但在广泛使用双侧 CB 消融之前需要谨慎，因为这会消除对低氧的通气反应，并可能损害压力感受器功能。
