Orthostatic responses to anticholinesterase inhibition in spinal cord injury.
Orthostatic responses to anticholinesterase inhibition in spinal cord injury.
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脊髓损伤中抗胆碱酯酶抑制的直立反应。
DOI：
10.1007/s10286-015-0272-3
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Kirshblum,StevenC
中科院分区：
文献类型：
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作者：
Wecht,JillM;Cirnigliaro,ChristopherM;Azarelo,Frank;Bauman,WilliamA;Kirshblum,StevenC
简介乙酰胆碱（Ach）是交感神经系统的突触前神经递质。突触前 Ach 增加可能会增加突触后去甲肾上腺素的释放，从而增加全身血压 (BP)。 目的本研究的主要目的是确定在脊髓损伤 (SCI) 个体中，与不使用药物 (NO-D) 相比，溴化吡斯的明 (PYRIDO：60 mg)（一种 Ach 抑制剂 (AchI)）在抬头倾斜 (HUT) 期间对血流动力学的影响。其次，我们的目的是确定与 NO-D 相比，PYRIDO 对直立不耐受 (OI) 症状和不良事件报告 (AE) 的影响。方法对 10 名 SCI (C4-C7) 个体进行两次研究：访问 (1) NO-D 和访问 (2) PYRIDO。每次访视时，受试者都经历了 15°、25°、35° 的渐进式 HUT 操作，每个角度持续 5 分钟，45° 持续 45 分钟。仰卧位和直立位心率 (HR)、收缩压和舒张压（SBP 和 DBP）以及 OI 和 AE 的监测和症状均被监测和记录。结果 试验之间的仰卧血流动力学没有差异。使用 PYRIDO 可以减少 NO-D 试验期间收缩压的显着下降，与 NO-D 试验相比，使用 PYRIDO 进行 HUT 期间，5 名受试者的舒张压有所增加。对 PYRIDO 有反应且体位血压升高的个体的静息心率显着低于无反应者 (p< 0.01)，这表明突触前 Ach 水平升高。两项试验之间 OI 和 AE 报告的主观症状没有差异。结论这些初步数据表明 PYRIDO 是安全的，并且可能有效改善特定 SCI 个体的血压直立性下降。
IntroductionAcetylcholine (Ach) is the pre-synaptic neurotransmitter of the sympathetic nervous system. Increased pre-synaptic Ach may augment post-synaptic release of norepinephrine, thereby increasing systemic blood pressure (BP).ObjectivesThe primary objective of this investigation was to determine the hemodynamic effect of pyridostigmine bromide (PYRIDO: 60 mg), an Ach inhibitor (AchI), compared to no-drug (NO-D) during head-up tilt (HUT) in individuals with spinal cord injury (SCI). Secondarily, we aimed to determine the effects of PYRIDO compared to NO-D on symptoms of orthostatic intolerance (OI) and adverse event reporting (AE).MethodsTen individuals with SCI (C4-C7) were studied on two occasions: visit (1) NO-D and visit (2) PYRIDO. On each visit subjects underwent a progressive HUT maneuver to 15°, 25°, 35° for 5 min at each angle and 45 min at 45°. Supine and orthostatic heart rate (HR), systolic and diastolic BP (SBP and DBP), as well as monitored and symptoms of OI and AE were monitored and recorded.ResultsSupine hemodynamics did not differ between the trials. The significant fall in SBP during the NO-D trial was diminished with PYRIDO, and five subjects had an increased DBP during HUT with PYRIDO compared to the NO-D trial. Individuals that responded to PYRIDO with an increase in orthostatic BP had significantly lower resting HR than non-responders (p< 0.01), which suggests increased levels of pre-synaptic Ach. Subjective symptoms of OI and AE reporting did not differ between the two trials.ConclusionsThese preliminary data suggest that PYRIDO is safe and may be effective at ameliorating the orthostatic fall in BP in select individuals with SCI.