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子痫前期与肌肉交感神经反应升高无关。

Preeclampsia is not associated with elevated muscle sympathetic reactivity.

机构信息

Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

出版信息

J Appl Physiol (1985). 2021 Jan 1;130(1):139-148. doi: 10.1152/japplphysiol.00646.2020. Epub 2020 Nov 19.

Abstract

To determine whether increased chemoreflex tonic activity is associated with augmented muscle sympathetic nervous system activity (MSNA) in women diagnosed with preeclampsia. Women with preeclampsia ( = 19; 32 ± 5 yr old, 31 ± 3 wk of gestation) were matched by age and gestational age with pregnant women (controls, = 38, 32 ± 4 yr old, 31 ± 4 wk gestation; 2:1 ratio). MSNA ( = 9 preeclampsia) was assessed during baseline, peripheral chemoreflex deactivation (hyperoxia), and a cold pressor test (CPT). Baroreflex gain and diastolic blood pressure at which there is a 50% likelihood of MSNA occurring (T50) and plasma noradrenaline concentrations were measured. Baseline mean arterial pressure (MAP: 106 ± 11 vs. 87 ± 10 mmHg, < 0.0001), noradrenaline concentrations (498 ± 152 pg/mL vs. 326 ± 147, = 0.001), and T50 (79 ± 7 vs. 71 ± 9 mmHg, = 0.02) were greater in women with preeclampsia than in controls. However, baseline MSNA (burst incidence [BI]: 41 ± 16 vs. 45 ± 13 bursts/100 hb, = 0.4) was not different between groups. Responses to hyperoxia (ΔBI -5 ± 7 vs. -1 ± 8 bursts/100 hb, = 0.1; ΔMAP -1 ± 3 vs. -2 ± 3 mmHg, = 0.7) and CPT (ΔBI 15 ± 7 vs. 12 ± 11 bursts/100 hb, = 0.6; ΔMAP 10 ± 4 vs. 12 ± 11 mmHg, = 0.6) were not different between groups. Our findings question the assumption that increased MSNA contributes to hypertension in women with preeclampsia. The chemoreflex does not appear to contribute to an increase in MSNA in women with preeclampsia. We wanted to determine whether increased chemoreflex tonic activity is associated with augmented muscle sympathetic nervous system activity (MSNA) in women diagnosed with preeclampsia. The chemoreflex does not contribute to increased MSNA in women with preeclampsia. Our data also challenge the belief that preeclampsia is associated with sympathetic neural hyperactivity. Thus, targeting sympathetic neural hyperactivity as therapeutic strategy is unlikely to be the most efficacious approach to treatment and management.

摘要

为了确定在诊断为子痫前期的女性中,化学感受器反射紧张性活动增加是否与肌肉交感神经活动(MSNA)增强有关。我们匹配了患有子痫前期的女性( = 19;32 ± 5 岁,妊娠 31 ± 3 周)和孕妇(对照组, = 38,32 ± 4 岁,妊娠 31 ± 4 周;2:1 比例)的年龄和孕龄。在基线、外周化学感受器去激活(高氧)和冷加压试验(CPT)期间评估 MSNA( = 9 例子痫前期)。测量了压力反射增益和舒张压(MSNA 发生的可能性为 50%的 T50)以及血浆去甲肾上腺素浓度。与对照组相比,子痫前期女性的基线平均动脉压(MAP:106 ± 11 对 87 ± 10mmHg, < 0.0001)、去甲肾上腺素浓度(498 ± 152pg/mL 对 326 ± 147, = 0.001)和 T50(79 ± 7 对 71 ± 9mmHg, = 0.02)更高。然而,两组间的基线 MSNA(爆发发生率[BI]:41 ± 16 对 45 ± 13 次/100 hb, = 0.4)无差异。两组对高氧(ΔBI -5 ± 7 对 -1 ± 8 次/100 hb, = 0.1;ΔMAP -1 ± 3 对 -2 ± 3mmHg, = 0.7)和 CPT(ΔBI 15 ± 7 对 12 ± 11 次/100 hb, = 0.6;ΔMAP 10 ± 4 对 12 ± 11mmHg, = 0.6)的反应无差异。我们的发现对增加的 MSNA 导致子痫前期女性高血压的假设提出了质疑。在子痫前期女性中,化学感受器反射似乎不会导致 MSNA 增加。我们想确定在诊断为子痫前期的女性中,化学感受器反射紧张性活动增加是否与肌肉交感神经活动(MSNA)增强有关。化学感受器反射不会导致子痫前期女性的 MSNA 增加。我们的数据还挑战了这样一种信念,即子痫前期与交感神经活动过度有关。因此,将交感神经活动过度作为治疗策略不太可能是最有效的治疗和管理方法。

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