妊娠高血压中交感动作电位发放和募集模式异常。
Sympathetic Action Potential Firing and Recruitment Patterns Are Abnormal in Gestational Hypertension.
机构信息
Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX (M.B.B., J.-K.Y., S.L.H., Q.F.).
University of Texas Southwestern Medical Center, Dallas, TX (M.B.B., J.-K.Y., S.L.H., D.B.N., Q.F.).
出版信息
Hypertension. 2023 Feb;80(2):291-301. doi: 10.1161/HYPERTENSIONAHA.122.19754. Epub 2022 Sep 6.
BACKGROUND
We tested the hypothesis that women who develop gestational hypertension (GH) display abnormal sympathetic action potential (AP) discharge patterns during late pregnancy (32-36 weeks), both at supine rest and during postural stress.
METHODS
Thirteen nonpregnant, female controls (nonpregnant controls [CTRL]) and 32 pregnant women participated; 14 had low-risk (no personal history of GH) normal pregnancies (LR-NP), 10 had high-risk (personal history of GH) normal pregnancies (HR-NP), and 8 developed GH. We measured heart rate, blood pressure, and muscle sympathetic nerve activity (microneurography) at supine rest and 60° head-up tilt. Sympathetic AP patterns were studied using wavelet-based methodology.
RESULTS
At rest, muscle sympathetic nerve activity burst frequency was elevated in LR-NP, HR-NP, and GH versus CTRL (all ≤0.01); however, the AP content per integrated burst was augmented only in GH (20±5 spikes/burst), compared with CTRL (8±3 spikes/burst), LR-NP (9±2 spikes/burst) and HR-NP (11±4 spikes/burst; all <0.0001). Thus, total AP firing frequency was greater in GH versus each of CTRL, LR-NP, and HR-NP (all <0.0001). In pregnancy, AP frequency is related directly to systolic (R=46%) and diastolic (R=20%) blood pressure (both ≤0.01). Unlike CTRL (both <0.01), women who developed GH were unable to increase within-burst AP firing (=0.71) or recruit latent subpopulations of larger-sized APs (=0.72) in response to head-up tilt, perhaps related to a ceiling-effect; however, total AP firing frequency in the upright posture was elevated in the GH cohort versus CTRL, LR-NP, and HR-NP (all <0.05).
CONCLUSIONS
Women who develop GH display aberrant sympathetic AP firing patterns in both the supine and upright postures.
背景
我们检验了这样一个假设，即在妊娠晚期（32-36 周），无论是在仰卧休息还是在姿势应激期间，患有妊娠高血压（GH）的女性会表现出异常的交感神经动作电位（AP）放电模式。
方法
13 名非妊娠女性对照组（非妊娠对照组[CTRL]）和 32 名孕妇参与了研究；其中 14 名孕妇为低危（无 GH 个人病史）正常妊娠（LR-NP），10 名孕妇为高危（有 GH 个人病史）正常妊娠（HR-NP），8 名孕妇发展为 GH。我们在仰卧休息和 60°头高位倾斜时测量心率、血压和肌肉交感神经活动（微神经记录）。使用基于小波的方法研究交感神经 AP 模式。
结果
在休息时，LR-NP、HR-NP 和 GH 组的肌肉交感神经活动爆发频率均高于 CTRL 组（均≤0.01）；然而，每个整合爆发的 AP 含量仅在 GH 组中增加（20±5 个 spikes/burst），与 CTRL 组（8±3 个 spikes/burst）、LR-NP 组（9±2 个 spikes/burst）和 HR-NP 组（11±4 个 spikes/burst）相比（均<0.0001）。因此，GH 组的总 AP 放电频率高于 CTRL、LR-NP 和 HR-NP 组（均<0.0001）。在妊娠期间，AP 频率与收缩压（R=46%）和舒张压（R=20%）直接相关（均≤0.01）。与 CTRL 不同（均<0.01），发生 GH 的女性在头高位倾斜时无法增加爆发内的 AP 放电（=0.71）或募集更大尺寸的潜在亚群 AP（=0.72），这可能与上限效应有关；然而，GH 组在直立姿势下的总 AP 放电频率高于 CTRL、LR-NP 和 HR-NP 组（均<0.05）。
结论
患有 GH 的女性在仰卧和直立姿势下均表现出异常的交感神经 AP 放电模式。
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