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在女性和男性中化学反射和肌肉机械反射相互作用对血液动力学的影响:两个故事,一个结论。

On the haemodynamic consequence of the chemoreflex and muscle mechanoreflex interaction in women and men: two tales, one story.

机构信息

Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.

Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, UT, USA.

出版信息

J Physiol. 2022 Aug;600(16):3671-3688. doi: 10.1113/JP283051. Epub 2022 Jul 7.

Abstract

The cardiovascular response resulting from the individual activation of the muscle mechanoreflex (MMR) or the chemoreflex (CR) is different between men and women. Whether the haemodynamic consequence resulting from the interaction of these sympathoexcitatory reflexes is also sex-dependent remains unknown. MMR and CR were activated by passive leg movement (LM) and exposure to hypoxia (O -CR) or hypercapnia (CO -CR), respectively. Twelve young men and 12 young women completed two experimental protocols: (1) resting in normoxia (P O : ∼83 mmHg, P CO : ∼34 mmHg), normocapnic hypoxia (P O : ∼48 mmHg, P CO : ∼34 mmHg) and hyperoxic hypercapnia (P O : ∼524 mmHg, P CO : ∼44 mmHg); (2) LM under the same gas conditions. During the MMR:O -CR coactivation, in men, the observed mean arterial pressure (MAP) and cardiac output (CO) were not different (additive effect), while the observed leg blood flow (LBF) and vascular conductance (LVC) were significantly lower (hypo-additive), compared with the sum of the responses elicited by each reflex alone. In women, the observed MAP was not different (additive) while the observed CO, LBF and LVC were significantly greater (hyper-additive), compared with the summated responses. During the MMR:CO -CR coactivation, in men, the observed MAP, CO and LBF were not different (additive), while the observed LVC was significantly lower (hypo-additive), compared with the summated responses. In women, the observed MAP was significantly higher (hyper-additive), while the observed CO, LBF and LVC were not different (additive), compared with the summated responses. The interaction of the MMR and CR has a pronounced influence on the autonomic cardiovascular control, with the haemodynamic consequences differing between men and women. KEY POINTS: The cardiovascular response resulting from the activation of the muscle mechanoreflex (MMR) or the chemoreflex (CR) was previously shown to be different between women and men; this study focused on the haemodynamic consequence of the interaction of these two sympathoexcitatory reflexes. MMR and CR were activated by passive leg movement and exposure to hypoxia (O -CR) or hypercapnia (CO -CR), respectively. Individual and interactive reflex effects on central and peripheral haemodynamics were quantified in healthy young women and men. In men, the MMR:O -CR and MMR:CO -CR interactions restricted peripheral haemodynamics, likely by potentiating sympathetic vasoconstriction. In women, the MMR:O -CR interaction facilitated central and peripheral haemodynamics, likely by potentiating sympathetic vasodilatation; however, the MMR:CO -CR interaction was simply additive for the central and peripheral haemodynamics. The interaction between the MMR and the CR exerts a profound influence on the autonomic control of cardiovascular function in humans, with the haemodynamic consequences differing between women and men.

摘要

个体肌肉机械感受器反射(MMR)或化学感受器反射(CR)的激活所导致的心血管反应在男性和女性之间存在差异。这些交感神经兴奋反射相互作用所导致的血流动力学后果是否也存在性别依赖性尚不清楚。MMR 和 CR 分别通过被动腿部运动(LM)和暴露于低氧(O-CR)或高碳酸血症(CO-CR)来激活。12 名年轻男性和 12 名年轻女性完成了两个实验方案:(1)在常氧(P O:83mmHg,P CO:34mmHg)、常氧低氧(P O:48mmHg,P CO:34mmHg)和高氧高碳酸血症(P O:524mmHg,P CO:44mmHg)下静息;(2)在相同气体条件下进行 LM。在 MMR:O-CR 共同激活期间,男性中观察到的平均动脉压(MAP)和心输出量(CO)没有差异(相加效应),而观察到的腿部血流(LBF)和血管传导性(LVC)显著降低(低加性),与每个反射单独引起的反应之和相比。在女性中,观察到的 MAP 没有差异(相加),而观察到的 CO、LBF 和 LVC 显著增加(超加性),与总和反应相比。在 MMR:CO-CR 共同激活期间,男性中观察到的 MAP、CO 和 LBF 没有差异(相加),而观察到的 LVC 显著降低(低加性),与总和反应相比。在女性中,观察到的 MAP 显著升高(超加性),而观察到的 CO、LBF 和 LVC 没有差异(相加),与总和反应相比。MMR 和 CR 的相互作用对自主心血管控制有明显影响,其血流动力学后果在男性和女性之间存在差异。关键点:先前的研究表明,肌肉机械感受器反射(MMR)或化学感受器反射(CR)的激活所导致的心血管反应在女性和男性之间存在差异;本研究重点关注这两种交感神经兴奋反射相互作用的血流动力学后果。MMR 和 CR 分别通过被动腿部运动和暴露于低氧(O-CR)或高碳酸血症(CO-CR)来激活。在健康的年轻女性和男性中,量化了个体和交互反射对中枢和外周血液动力学的影响。在男性中,MMR:O-CR 和 MMR:CO-CR 相互作用限制了外周血液动力学,可能通过增强交感神经血管收缩。在女性中,MMR:O-CR 相互作用促进了中枢和外周血液动力学,可能通过增强交感神经血管舒张;然而,MMR:CO-CR 相互作用对中枢和外周血液动力学只是相加的。MMR 和 CR 之间的相互作用对人类自主心血管功能的控制产生了深远的影响,其血流动力学后果在女性和男性之间存在差异。

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