Neuroendocrine manifestations of congestive heart failure.
Neuroendocrine manifestations of congestive heart failure.
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充血性心力衰竭的神经内分泌表现。
DOI：
10.1016/s0002-9149(88)80078-x
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
Francis,GS
中科院分区：
文献类型：
--
作者：
Francis,GS
充血性心力衰竭是一种复杂的临床综合征，其特征是多种神经内分泌反应。这些反应可能是旨在保护容量和维持循环稳态的机制的进化遗迹。心力衰竭患者的交感神经系统和肾素-血管紧张素-醛固酮系统的激活以及加压素的释放已被清楚地记录下来。与正常心室不同，衰竭心室对外周血管收缩和钠潴留做出反应，导致进一步的血流动力学障碍和循环充血。某些血管舒张利尿钠物质在心力衰竭期间也会释放，可能是为了抵消过度的外周收缩和钠潴留。发现一些心力衰竭患者的前列腺素E2、心房钠尿肽（或心房钠尿因子）和血浆多巴胺升高。然而，外周收缩和钠潴留似乎占主导地位，特别是在心力衰竭的晚期。对这些神经内分泌反应的了解导致了治疗的新发展。血管紧张素转换酶抑制剂已成为治疗心力衰竭的明显有用的药物。旨在阻止过度交感神经驱动和抑制加压素的药物正在研究中。心力衰竭患者输注心钠素和使用选择性多巴胺激动剂的临床试验也在进行中。对神经内分泌反应的了解的增加可能会带来更新、更有想象力的治疗方法。
Congestive heart failure is a complex clinical syndrome characterized by a number of neuroendocrine responses. These responses are probably an evolutionary vestige of mechanisms designed to defend volume and maintain circulatory homeostasis. Activation of the sympathetic nervous system and renin-angiotensin-aldosterone system and the release of vasopressin have been clearly documented in patients with heart failure. Unlike the normal ventricle, the failing ventricle responds to peripheral vasoconstriction and sodium retention with further hemodynamic embarrassment and circulatory congestion. Certain vasorelaxant natriuretic substances are also released during heart failure, perhaps in an attempt to offset excessive peripheral constriction and sodium retention. Prostaglandin E2, atrial natriuretic peptide (or atrial natriuretic factor) and plasma dopamine are found to be increased in some patients with heart failure. However, peripheral constriction and sodium retention appear to be dominant, particularly in the advanced stages of heart failure. An understanding of these neuroendocrine responses has led to new developments in therapy. Angiotensin-converting enzyme inhibitors have emerged as distinctly useful drugs in the treatment of heart failure. Agents designed to block excessive sympathetic drive and inhibit vasopressin are under investigation. Infusion of atrial natriuretic factors and the use of selective dopamine agonists are also undergoing clinical trials in patients with heart failure. Increased knowledge of the neuroendocrine responses will likely result in even newer and more imaginative therapy.