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应激、低血糖与自主神经系统。

Stress, hypoglycemia, and the autonomic nervous system.

机构信息

Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA.

Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.

出版信息

Auton Neurosci. 2022 Jul;240:102983. doi: 10.1016/j.autneu.2022.102983. Epub 2022 Apr 4.


DOI:10.1016/j.autneu.2022.102983
PMID:35417827
Abstract

Stress can be classified as either psychosocial or physiologic. Physiologic stress refers to stresses due to acute illness, trauma, pain, hypoglycemia, and sleep deprivation-much less is known regarding its health consequences. This review focuses on hypoglycemia as a model to further investigate physiological stress. Experimental mild to moderate hypoglycemia is a paradigmatic physiological stress that evokes autonomic, neuroendocrine, and immune responses. Hypoglycemic stress is an ideal model to examine the interactions and consequences of physiological stress on the autonomic nervous system. Acute hypoglycemia has been demonstrated to increase inflammatory markers, prolong QTc, and impair cardiac-vagal baroreflex sensitivity. Some of these consequences may not reverse completely when euglycemia is restored. For example, there is attenuation of the cardiac-vagal baroreflex, attenuation of the vascular sympathetic baroreflex (muscle sympathetic nerve activity response to transient hypotension), and attenuation of the catecholamine response to lower body negative pressure that is present the next day after hypoglycemia has resolved.

摘要

压力可以分为心理社会压力或生理压力。生理压力是指由于急性疾病、创伤、疼痛、低血糖和睡眠剥夺引起的压力——关于其对健康的影响知之甚少。本篇综述专注于低血糖作为模型来进一步研究生理压力。实验性的轻度至中度低血糖是一种典型的生理性应激,会引起自主神经、神经内分泌和免疫反应。低血糖应激是研究生理应激对自主神经系统相互作用和影响的理想模型。研究已经证实,急性低血糖会增加炎症标志物、延长 QTc 并损害心脏迷走神经压力反射敏感性。其中一些后果在恢复正常血糖后可能不会完全逆转。例如,在低血糖解决后的第二天,心脏迷走神经压力反射、血管交感神经压力反射(肌肉交感神经活动对短暂性低血压的反应)和儿茶酚胺对下体负压的反应都会减弱。

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