CORONARY MICROCIRCULATION - AUTOREGULATION AND METABOLIC CONTROL
CORONARY MICROCIRCULATION - AUTOREGULATION AND METABOLIC CONTROL
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DOI：
10.1007/bf00789441
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发表时间：
1995-03-01
影响因子：
9.5
通讯作者：
CHILIAN, WM
中科院分区：
文献类型：
--
作者：
DEFILY, DV;CHILIAN, WM
大多数关于冠状动脉血流和血管阻力调节的研究都认为冠状动脉循环由大导管血管和阻力血管组成。近年来，人们发现冠状动脉微血管阻力的调节并不是均匀分布的，而是在不同的血管段或微域之间存在差异。一般来说，直径小于100 μ m的小动脉的反应与大动脉和小动脉不同。在这些不同微血管域的自身调节控制、肌源性控制、内皮调节和代谢因子控制水平上存在主要差异。也有跨壁变异，这可能解释了在心外膜和心内膜区域之间观察到的冠状动脉血液的一些差异。此外，这些不同调节机制之间的相互作用进一步使对冠状动脉微血管调节的理解复杂化。然而，重要的是，可能是这些复杂的相互作用和异质调节机制允许心肌在极端代谢条件下的充分灌注。这种调节的分段分布提出了一种调节的综合假说，即各种机制在总体反应中发挥作用。
The majority of studies examining the regulation of coronary blood flow and vascular resistance have considered the coronary circulation as being composed of large conduit vessels and resistance vessels. Recently, it has become apparent that regulation of coronary microvascular resistance is not distributed uniformly, but varies across different segments or microdomains of the vasculature. Generally, small arterioles, those less than 100 mu m in diameter, respond differently than larger arterioles and small arteries. There are major differences in the level of autoregulatory control, myogenic control, endothelial modulation and control by metabolic factors across these various microvascular domains. There are also transmural variations which may account for some of the differences in coronary blood observed between epicardial and endocardial regions. In addition, interactions between these various regulatory mechanisms further complicate the understanding of coronary microvascular regulation. Importantly however, it may be these complex interactions and heterogeneous regulatory mechanisms which allow for adequate perfusion of the myocardium under an extreme range of metabolic conditions. This segmental distribution of regulation suggests an integrative hypothesis of regulation whereby a variety of mechanisms play a role in the overall response.