中国神经再生研究(英文版) ›› 2017, Vol. 12 ›› Issue (9): 1390-1400.doi: 10.4103/1673-5374.215241

• 综述:脊髓损伤修复保护与再生 • 上一篇    下一篇

自主神经反射异常:脊髓损伤后的心血管疾病

  

  • 收稿日期:2017-08-15 出版日期:2017-09-15 发布日期:2017-09-15

Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury

Shaoping Hou   

  1. Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA
  • Received:2017-08-15 Online:2017-09-15 Published:2017-09-15
  • Contact: Hisham Sharif, Ph.D.,hs598@drexel.edu.
  • Supported by:

    This work was supported by NIH NINDS R01NS099076, Morton Cure Paralysis Funds (MCPF).

摘要:

 

 

orcid:0000-0003-2611-8907(Hisham Sharif)

Abstract:

 

Autonomic dysreflexia (AD) is a serious cardiovascular disorder in patients with spinal cord injury (SCI). The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons (SPNs) caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic per­formance, which holds promise as a potential therapeutic approach.

Key words: autonomic dysreflexia, hyper-reflexia, sympathetic dysfunction, C-fibers, propriospinal axons, α-adrenoceptors, stem cell transplantation