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Translating carotid body function into clinical medicine

机译:将颈动脉机体功能转化为临床医学

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摘要

The carotid body (CB) is considered the main O2 chemoreceptor, which contributes to cardiorespiratory homeostasis and ventilatory acclimatization. In clinical medicine, the most common pathologies associated with the CB are tumours. However, a growing body of evidence supports the novel idea that an enhanced CB chemosensory discharge contributes to the autonomic dysfunction and pathological consequences in obstructive sleep apnoea (OSA), hypertension, systolic heart failure (HF) and cardiometabolic diseases. Heightened CB chemosensory reactivity elicited by oxidative stress has been involved in sympathetic hyperactivity, cardiorespiratory instability, hypertension and insulin resistance. CB ablation, which reduces sympathetic hyperactivity, decreases hypertension in animal models of OSA and hypertension, eliminates breathing instability and improves animal survival in HF, and restores insulin tolerance in cardiometabolic models. Thus, data obtained from preclinical studies highlight the importance of the CB in the progression of sympathetic‐related diseases, supporting the idea that appeasing the enhanced CB chemosensory drive may be useful in improving cardiovascular, respiratory and endocrine alterations. Accordingly, CB ablation has been proposed and used as a treatment for moderating resistant hypertension and HF‐induced sympathetic hyperactivity in humans. First‐in‐human studies have shown that CB ablation reduces sympathetic overactivity, transiently reduces severe hypertension and improves quality of life in HF patients. Thus, CB ablation would be a useful therapy to reverse sympathetic overactivation in HF and severe hypertension, but caution is required before it is widely used due to the crucial physiological function played by the CB. Further studies in preclinical models are required to assess side‐effects of CB ablation.
机译:颈动脉(CB)被认为是主要的O2化学感受器,有助于心肺稳态和通气适应。在临床医学中,与CB相关的最常见病理是肿瘤。然而,越来越多的证据支持这样的新观点:增强的CB化学感觉放电会导致阻塞性睡眠呼吸暂停(OSA),高血压,收缩性心力衰竭(HF)和心脏代谢性疾病的自主神经功能障碍和病理后果。氧化应激引起的CB化学感应反应性升高与交感神经过度活跃,心肺不稳定性,高血压和胰岛素抵抗有关。 CB消融可减少交感神经亢进,降低OSA和高血压动物模型中的高血压,消除呼吸不稳定性并改善HF中动物的存活率,并恢复心脏代谢模型中的胰岛素耐受性。因此,从临床前研究获得的数据突显了CB在交感神经相关疾病进展中的重要性,支持了以下观点:缓解CB化学感觉驱动的增强可能有助于改善心血管,呼吸和内分泌的改变。因此,已经提出了消融炭黑的方法,并将其用作减轻人的抗药性高血压和HF诱发的交感神经亢进的治疗方法。首次人体研究表明,CB消融可减少HF患者的交感神经过度活动,暂时减轻严重高血压并改善生活质量。因此,CB消融将是一种可逆转HF和严重高血压的交感神经过度活化的有用疗法,但是由于CB发挥着至关重要的生理功能,因此在广泛使用之前需要谨慎。需要对临床前模型进行进一步研究以评估CB消融的副作用。

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