The functional ambivalence of adaptive processes--considerations based on the example of the hemodynamically overloaded heart.
The functional ambivalence of adaptive processes--considerations based on the example of the hemodynamically overloaded heart.
复制标题
适应性过程的功能性矛盾——基于血流动力学超负荷心脏的例子的考虑。
DOI：
--
复制
发表时间：
1991
影响因子：
9.5
通讯作者：
R. Jacob
中科院分区：
文献类型：
--
作者：
R. Jacob
以心脏肥大和血流动力学过载中的神经体液反应为例，说明适应性过程在原则上使整个器官能够应对增加的负荷的同时，通常也包括不利的成分。这主要是由于关于例如机械或能量参数的不同需求之间的竞争。令人印象深刻的是，适应过程的矛盾可以在心肌质量增加、偏心构型变化以及心肌向“较慢的肌肉”转变的功能后果中看到。可以证明，由于心脏的结构改变，从一开始就在整个器官的水平上以及在大分子层面上都发生了不利的影响，而不仅仅是由于质的和量的不适当适应的结果。因此，明确区分“生理”和“病理”过程几乎是不可能的。在临床上，往往强调肥大过程的不利影响，并宣布减少肥厚是主要的治疗目标。然而，在个别病例中，血管改变在多大程度上参与或甚至主要负责发生在压力肥厚中的不利影响，应该得到澄清。无论如何，减少血流动力学过载应是治疗关注的重点。
Cardiac hypertrophy and neuro-humoral reactions in hemodynamic overload are employed as examples to show that adaptive processes, while in principle enabling the whole organ to cope with increased load, as a rule also include unfavorable components. This is primarily due to competition between different demands with respect to, for instance, mechanical or energetic parameters. An impressive demonstration of the ambivalence of adaptive processes can be seen in the functional consequences of myocardial mass increase, eccentric configurational changes, and the alteration of the myocardium towards a "slower muscle". It can be demonstrated that, due to structural modifications in the heart, unfavorable effects occur at the level of the whole organ as well as in macromolecular dimensions from the very beginning, and not only as a consequence of qualitatively and quantitatively inappropriate adaptation. Thus, a clear-cut distinction between "physiological" and "pathological" processes is almost impossible. In the clinic, the unfavorable effects of the process of hypertrophy are often emphasized and the reduction of hypertrophy is declared the principal therapeutic aim. However, in the individual case the extent to which vascular alterations participate in, or are even mainly responsible for the unfavorable effects occurring in pressure hypertrophy should be clarified. In any case, reduction of hemodynamic overload should be the focus of therapeutic concern.
正常和慢性高血压狒狒的心脏β肌球蛋白重链多样性。
DOI：
10.1172/jci114042
发表时间：
1989
期刊：
The Journal of clinical investigation
影响因子：
--
作者：
Henkel,RD;VandeBerg,JL;Shade,RE;Leger,JJ;Walsh,RA
通讯作者：
Walsh,RA