Chewing-induced hypertension in afferent baroreflex failure: a sympathetic response?
Chewing-induced hypertension in afferent baroreflex failure: a sympathetic response?
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DOI：
10.1113/ep085340
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发表时间：
2015-11-01
影响因子：
2.7
通讯作者：
Kaufmann, Horacio
中科院分区：
文献类型：
--
作者：
Mora, Cristina Fuente;Norcliffe-Kaufmann, Lucy;Kaufmann, Horacio
新发现这项研究的中心问题是什么？我们的目标是通过记录咀嚼、吞咽和胃膨胀时血压和心率的变化，了解先天性传入压力反射衰竭患者进食时的自主神经反应。主要发现是什么及其重要性？出生时传入压力感受器通路受损的患者对食物摄入有夸张的压力反应。这似乎是一种交感介导的反应，由咀嚼引起，独立于吞咽或胃胀而发生。咀嚼诱导的升压反应可能有助于预防这些患者的直立性低血压。家族性自主神经异常（FD）是一种罕见的遗传性疾病，由压力反射性神经传递障碍引起血压极不稳定。病人的交感神经活动明显增加，通常是在吃饭前后。我们进行了一项观察性研究，记录FD患者进食时的自主神经反应，并确定交感神经激活是否由咀嚼、吞咽或胃胀引起。连续测量咀嚼口香糖（n=15）、进食（n=20）和经皮内镜胃造口管喂养扩胃（n=9）时的血压和R-R间隔。将反应与正常对照（n=10）和传出自主神经衰竭（n=10）慢性交感神经流出受损患者的反应进行比较。在FD患者中，进食与明显但短暂的升压反应相关(P
New FindingsWhat is the central question of this study? Our goal was to understand the autonomic responses to eating in patients with congenital afferent baroreflex failure, by documenting changes in blood pressure and heart rate with chewing, swallowing and stomach distension.What is the main finding and its importance? Patients born with lesions in the afferent baroreceptor pathways have an exaggerated pressor response to food intake. This appears to be a sympathetically mediated response, triggered by chewing, that occurs independently of swallowing or distension of the stomach. The chewing-induced pressor response may be useful as a counter-manoeuvre to prevent orthostatic hypotension in these patients.Familial dysautonomia (FD) is a rare genetic disease with extremely labile blood pressure resulting from baroreflex deafferentation. Patients have marked surges in sympathetic activity, frequently surrounding meals. We conducted an observational study to document the autonomic responses to eating in patients with FD and to determine whether sympathetic activation was caused by chewing, swallowing or stomach distension. Blood pressure and R-R intervals were measured continuously while chewing gum (n=15), eating (n=20) and distending the stomach by percutaneous endoscopic gastrostomy tube feeding (n=9). Responses were compared with those of normal control subjects (n=10) and of patients with efferent autonomic failure (n=10) who have chronically impaired sympathetic outflow. In patients with FD, eating was associated with a marked but transient pressor response (P