Mohammed Alsaleh, Aryan Talati, Satish R Raj, Robert S Sheldon
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引用次数: 0
Abstract
Purpose: The goal of this manuscript was to review the biological and clinical evidence that serotonin neurotransmission might play an important role in the physiology and treatment of vasovagal syncope.
Methods: The authors reviewed PubMed and handsearches of secondary sources for papers related to the Bezold-Jarisch reflex and serotonin, the plausible involvement of the Bezold-Jarisch reflex in vasovagal syncope, and three lines of clinical evidence involving serotonin and the syncope.
Results: The Bezold-Jarisch reflex was first described following the infusion of veratrum alkaloids into animals in the 19th century. The reflex is triggered by serotonin stimulation chemoreceptors and mechanoreceptors in the the left ventricle. The afferent component of the reflex is carried by unmyelinated type C vagal nerve fibers, which results in parasympathetic efferent stimulation that causes bradycardia. The similarity of the combination of hypotension and bradycardia in the Bezold-Jarisch reflex and in vasovagal syncope led to the suggestion that the reflex was the cause of the syndrome. Three lines of evidence implicate the serotonin 5HT3 receptors in the heart in the reflex. There is genetic and physiologic evidence for the serotonin 5HT1A and 5HT3 receptors and the serotonin reuptake transporter (SERT). Acute blockade of SERT induces vasovagal syncope in humans undergoing head-up tilt table testing, and SERT inhibition reduces hypotension and bradycardia during spinal anaesthesia. Finally, three randomized clinical trials of SERT inhibitors uniformly reported that they significantly reduce the likelihood of vasovagal syncope recurrences.
Conclusion: Multiple lines of evidence implicate serotonin neurotransmission in the cause of vasovagal syncope.
目的:本手稿旨在回顾血清素神经传递可能在血管迷走性晕厥的生理学和治疗中发挥重要作用的生物学和临床证据:作者在PubMed和二手资料中检索了与Bezold-Jarisch反射和血清素有关的论文、Bezold-Jarisch反射在血管迷走性晕厥中的合理参与,以及涉及血清素和晕厥的三个临床证据:Bezold-Jarisch 反射最早是在 19 世纪向动物注射藜芦生物碱后描述的。该反射由血清素刺激左心室的化学感受器和机械感受器触发。该反射的传入部分由无髓鞘的 C 型迷走神经纤维传导,从而导致副交感神经传出刺激,引起心动过缓。Bezold-Jarisch 反射和血管迷走性晕厥中低血压和心动过缓的组合相似,因此有人认为该反射是导致该综合征的原因。 有三方面的证据表明,心脏中的血清素 5HT3 受体与该反射有关。血清素 5HT1A 和 5HT3 受体以及血清素再摄取转运体(SERT)都有遗传学和生理学证据。急性阻断 SERT 可诱发进行仰卧位测试的人发生血管迷走性晕厥,抑制 SERT 可减少脊髓麻醉过程中的低血压和心动过缓。最后,三项关于 SERT 抑制剂的随机临床试验一致报告称,这些抑制剂可显著降低血管迷走性晕厥复发的可能性:结论:多种证据表明,5-羟色胺神经递质与血管迷走性晕厥的病因有关。
期刊介绍:
Clinical Autonomic Research aims to draw together and disseminate research work from various disciplines and specialties dealing with clinical problems resulting from autonomic dysfunction. Areas to be covered include: cardiovascular system, neurology, diabetes, endocrinology, urology, pain disorders, ophthalmology, gastroenterology, toxicology and clinical pharmacology, skin infectious diseases, renal disease.
This journal is an essential source of new information for everyone working in areas involving the autonomic nervous system. A major feature of Clinical Autonomic Research is its speed of publication coupled with the highest refereeing standards.