Chronic heart failure does not attenuate the total activity of sympathetic outflow to skin during whole-body heating.
Chronic heart failure does not attenuate the total activity of sympathetic outflow to skin during whole-body heating.
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DOI：
10.1161/circheartfailure.112.000135
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发表时间：
2013-03
期刊：
影响因子：
--
通讯作者：
Sinoway LI
中科院分区：
文献类型：
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作者：
Cui J;Boehmer JP;Blaha C;Lucking R;Kunselman AR;Sinoway LI
以往的研究表明，在慢性心力衰竭（CHF）患者中，热应激期间皮肤血流量和皮肤血管传导性（CVC）的升高显著减弱。造成这一结果的机制尚不清楚。特别是，很少有人知道的反应，皮肤交感神经活动（SSNA），控制皮肤血流在热应激期间在CHF患者。我们研究了适度的热应激的影响，以检验在CHF中SSNA反应可以减弱的假设。我们评估了SSNA（显微神经造影术）从腓神经和皮肤血流（前臂激光多普勒）在9例稳定的II-III级CHF患者和匹配的健康受试者在被动全身加热与水灌注服。两组的全身加热诱导了相似的内部温度升高（约0.6 °C）。全身热应激诱发的SSNA激活在CHF患者（Δ891±110单位/分钟）和对照组（Δ787±84单位/分钟，P=0.66）中相似，而CHF患者前臂CVC的升高显著低于健康对照组（Δ131±29 vs. Δ623± 131%，P=0.001）。目前的数据表明，SSNA激活在一个温和的全身热应力并没有衰减CHF。因此，CHF患者的皮肤血管舒张反应减弱不是由于交感神经流出皮肤的总活性降低。
Previous studies show that the rise in skin blood flow and cutaneous vascular conductance (CVC) during heat stress is substantially attenuated in chronic heart failure (CHF) patients. The mechanism(s) responsible for this finding is not clear. In particular, little is known regarding the responses of skin sympathetic nerve activity (SSNA) that control the skin blood flow during heat stress in CHF patients. We examined the effects of a modest heat stress to test the hypothesis that SSNA responses could be attenuated in CHF. We assessed SSNA (microneurography) from the peroneal nerve and skin blood flow (forearm laser Doppler) in 9 patients with stable class II-III CHF and in matched healthy subjects during passive whole body heating with a water perfused suit. Whole body heating induced similar increases in internal temperature (~0.6 °C) in both groups. Whole body heat stress evoked similar SSNA activation in CHF patients (Δ891±110 units/min) and the control subjects (Δ787±84 units/min, P=0.66), while the elevation in forearm CVC in patients with CHF was significantly lower than that in healthy control subjects (Δ131±29 vs. Δ623±131%, P=0.001). The present data show that SSNA activation during a modest whole body heat stress is not attenuated in CHF. Thus, the attenuated skin vasodilator response in CHF patients is not due to a reduction in total activity of sympathetic outflow to skin.