1、II . Humoral regulation of cardiovascular system 心血管活動的體液調節2021/8/171II . Humoral regulation of 1. 腎素血管緊張素醛固酮系統(RAAS) 2. 腎上腺素和去甲腎上腺素 3. 血管升壓素 4. 血管內皮生成的活性物質 5. 心房鈉尿肽 6. 激肽釋放酶激肽系統2021/8/172 1. 腎素血管緊張素醛固酮系統(RAAS)2021/1. Renin-angiotension-aldosterone system(RAA腎素血管緊張素醛固酮系統(RAAS)2021/8/1731. Renin-angi

2、otension-aldoster交感神經興奮低血壓Na腎球旁細胞分泌腎素 血管緊張素原AI渴覺AIIADH心肌肥大血管增生全身血管收縮血容量腎臟水鈉潴留下丘腦腎上腺皮質醛固酮ACE2021/8/174交感神經興奮腎球旁細胞分泌腎素 血管緊張素原AI渴覺AII（1）Angiotonin II 血管緊張素II (AII) angiotensinogen ( 2-globulin) renin (kidney ) angiotensin(decapeptide)converting enzyme (pneumoangiogram) angiotensin(octapeptide) +AT1 rec

3、eptorangiotensinase A angiotensin (heptapeptide) 2021/8/175（1）Angiotonin II 血管緊張素II (AIIa. The formation of angiotonin 血管緊張素生成過程 血管緊張素原（肝合成） 腎素(腎近球細胞分泌） 血管緊張素（10肽） (轉化酶,主要在肺血管) 血管緊張素（8肽）AT1受體 血管緊張素酶A 血管緊張素III（7肽）2021/8/176a. The formation of angiotonib. Physiological function of angiotensin 血管緊張素的生理

4、作用 The systemic arterioles contracts and the peripheral resistance increases. 全身微動脈收縮，外周阻力。 The veins contracts and the returned blood increases. 靜脈收縮，回心血量。2021/8/177b. Physiological function of Prejunctional modulation, promote the sympathetic nerve ending to excrete NA. 接頭前調制，促進交感神經末梢釋放NA。 Action

5、on the specific receptors of CNS , the sympathesis vasoconstrictor tone . 作用于中樞特定受體，交感縮血管緊張。 Stimulate the formation and excretion of aldosterone， the reabsorption of sodium and fluid increases and thus the BP increases too. 刺激醛固酮生成分泌，水鈉重吸收，血壓。2021/8/1782021/8/178(2) Aldosterone 醛固酮Synthesis positio

6、n : adrenal cortex ZG cell合成部位：腎上腺皮質球狀帶細胞critical organ :distal tubule 、collecting duct靶器官：遠曲小管、集合管Function: to keep Na+ and excrete K+ .作用：保Na+排K+作用。 2021/8/179(2) Aldosterone 醛固酮2021/8/12021/8/17102021/8/1710mechanism of action作用機制 醛固酮促進小管上皮細胞Na+ 泵運轉促進生化氧化提供ATP增加管腔膜對Na+ 通透性促進Na+的主動重吸收 (保Na+) 造成小管腔

7、內負電位K+被分泌到小管液（排K+)2021/8/1711mechanism of action醛固酮促進小管上皮細胞2. Adrenaline(Adr) and noradrenaline (NA) 腎上腺素和去甲腎上腺素 Synthesis postion: 合成部位（1）adrenal medulla 腎上腺髓質 Adr： 80%, NE ：20% 腎上腺素：80，去甲腎上腺素 ：20 （2）adrenergic nerve ending 腎上腺素能神經末梢 Secrete NA only. 僅分泌少量的NA入血。 2021/8/17122. Adrenaline(Adr) and no

8、rad2021/8/17132021/8/1713腎上腺素 強心藥2021/8/1714腎上腺素 強心藥2021/8/1714去甲腎上腺素 升壓藥 2021/8/1715去甲腎上腺素 升壓藥 2021/8/1715 3. vasopressin (Antidiuretic hormone ) 血管升壓素（抗利尿激素） Synthesis position： supraoptic nucleus and paraventricular nucleus. Store in posterior pituitary gland and release to blood stream. 合成部位：在下丘

9、腦的視上核和室旁核合成。 在神經垂體后葉貯存，釋放到血液中發揮作用。 2021/8/1716 3. vasopressin (Antidiuretic V1 receptor: constriction of blood vessel increase in blood pressure. 結合V1受體：血管收縮,血壓。 V2 receptor: reabsorption of H2O from collecting duct increases. 結合V2受體：腎集合管對水的重吸收。 2021/8/17172021/8/1717 Physical function 生理功能 In norma

10、l condition , the increase in the level of ADH in plasma firstly induces the effect of antidiuresis,and only when its level increases definitely ,the BP increases. ADH plays an important role in the regulation of the volume of extracellular fluid .Under the condition of water bearing , water depleti

11、on and blood loss ,the secretion of ADH increases to keep the normal volume of body fluid and maintain the normal BP.2021/8/1718 Physical function 生理功能2021/8 正常情況下，血漿中ADH濃度升高時首先出現抗利尿效應，當其血漿濃度明顯升高時，才引起血壓升高。ADH對體內細胞外液量的調節起重要作用。在禁水、失水、失血等情況下，ADH釋放增加,保留體內液體量，維持動脈血壓。2021/8/17192021/8/17194. Endothelium-d

12、erived vasoactive substances 血管內皮生成的血管活性物質 (1) Endothelium-derived relaxing substances 血管內皮生成的舒血管物質Prostacyclin 前列環素（PGI2)Endothelium-derived relaxing factor NO 血管內皮舒張因子一氧化氮（NO） 2021/8/17204. Endothelium-derived vasoactEndothelium-derived relaxing factor NO 血管內皮舒張因子一氧化氮（NO）2021/8/1721Endothelium-der

13、ived relaxing fIn 1977 Murad Find glycerol trinitrate educe its endothelium- relaxing effect through NO. In 1980 Furchgott Presume Ach educe its its endothelium- relaxing effect through EDRF. In 1987 Moncada Certificate the EDRF is in fact NO through the way of “waterfall-type shower” .The finding p

14、rocess of NO2021/8/1722In 1977 Murad The finding prNO的發現過程1977年 默拉德（Murad） 確認硝酸甘油類物質舒張血管的作用通過釋放NO來實現。1980年 佛奇戈特(Furchgott) 推測Ach通過內皮細胞釋放的EDRF來實現其舒血管效應。1987年 蒙卡達(Moncada) 運用“瀑布式淋浴”方法證明EDRF即是NO。2021/8/1723NO的發現過程1977年 默拉德（Murad） 2021/Physical function of NONO的生理作用2021/8/1724Physical function of NO2021

15、/8/ACNOS血管舒張精氨酸NOcGMPCa2+i瓜氨酸NOS 活性：Ach，緩激肽，P物質，5HT,ATPNOS 活性：NA，ADH，AII 2021/8/1725ACNOS血管舒張精氨酸NOcGMPCa2+i瓜氨酸 Endothelin 內皮素（ET) 21肽 Vascular endothelial cell excretes , strong vasoconstrictor. 血管內皮細胞分泌的強縮血管物質。 Endothelin causes first decrease in BP and followed by long-term of the increase in BP.

16、內皮素在引發長時期血壓先出現血壓。 (2) Endothelium-derived vasoconstrictor substances 血管內皮生成的縮血管物質2021/8/1726 Endothelin 內皮素（ET) 21肽 (5. Atrial natriuretic peptide (ANP) 心房鈉尿肽(ANP) Synthesis position:atrial muscle cell (28 peptides) 合成部位：心房肌細胞，28肽 Target organ: heart, blood vessels, kidney, CNS 靶器官：心臟，血管，腎臟，中樞 The b

17、lood volume increases, the atrium wall stretches ANP . 血容量增加，心房壁受到牽拉ANP 。 2021/8/17275. Atrial natriuretic peptidePhysiological function 生理作用HR ,CO 心率，心輸出量。The blood vessel dilates and the peripheral resistance increases. 血管舒張，外周阻力。 To inhibit the activity of RAAS system,the secretion of water and s

18、odium increases. 抑制RAAS系統的活性，腎排水排鈉。To inhibit the secretion of ADH . 抑制血管升壓素的釋放。 2021/8/1728Physiological function 生理作用HR6. Kallikrein-kinin system 激肽釋放酶激肽系統（KKS) 組織激肽釋放酶低分子激肽原賴氨酰緩激肽緩激肽激肽酶I激肽酶II 失活高分子激肽原血漿激肽釋放酶氨基肽酶2021/8/17296. Kallikrein-kinin system組織激肽 Callidin and kallidin is the most intensive

19、vessel- relaxing substances. Kinin can relax the VSM and improve the capillary permeability ,but as to other SM elicit contraction. 緩激肽和賴氨酰緩激肽（血管舒張素）是已知的最強烈的舒血管物質。激肽可使血管平滑肌舒張和毛細血管通透性增高，但在其他平滑肌則引起收縮。2021/8/1730 2021/8/1730 III . Local regulation of blood flow 血流量的局部調節 1. Active hyperemia 主動充血 2. Bloo

20、d flow autoregulation 血流的自身調節2021/8/1731 III . Local regulation of blo The local regulation of blood flow is the organs and tissues to regulate its arteriole resistance and the blood flow depending on the factors of the organs and tissues but neural an hormonal mechanism. 血流量的局部調節是指器官或組織的微動脈阻力或血流量的改

21、變不取決于神經和激素機制，而是取決于器官和組織本身的調節。 2021/8/1732 The local regulation of blo1. Active hyperemia 主動充血 The phenomenon of the increase in the blood flow in most organs and tissues when their metabolism activity strengthen is called active hyperemia.It is caused by the relaxation of arterioles as a result of t

22、he activity of organs and tissues strengthen. 大多數器官和組織代謝活動增強時表現為血流量增加，稱為主動充血。主動充血是由于器官或組織活動增強時微動脈舒張的結果。 2021/8/17331. Active hyperemia 主動充血 The relaxation of arteriole is the result of the change of the concentration of the chemical reconstituent in extracellular fluid,which includes the decrease in

23、 OPP, the increase in the concentration of CO2, H+, adenosine, ATP etc. 主動充血時導致微動脈舒張的因素是微動脈周圍的 細胞外液化學成份的改變。這些因素包括氧分壓降 低、 CO2濃度、H+濃度、腺苷、ATP等升高。2021/8/1734 2021/8/17342. Blood flow autoregulation 血流量的自身調節 When the organ perfusion pressure changes, the arteriole resistance also change to keep the organ

24、 blood flow at a constant level, which is called the autoregulation of the blood flow. 當器官灌注壓發生變化時，該器官的微動脈阻力也發生改變，使器官的血流量保持相對恒定的現象稱為血流量的自身調節。 器官：腎臟、心臟、腦 2021/8/17352. Blood flow autoregulationThe mechanism of the blood flow autoregulation血流量自身調節的機制代謝性機制 metabolism mechanism肌源性機制 muscle-derived mecha

25、nism2021/8/1736The mechanism of the blood flometabolism mechanism代謝性機制BP 器官血流量氧分壓CO2， H+微動脈舒張血流量恢復主動充血：組織活動增強代謝產物增多微血管舒張代謝性機制：血流量不足代謝產物積聚 微血管舒張2021/8/1737metabolism mechanism代謝性機制BP muscle-derived mechanism肌源性機制血壓牽張血管平滑肌收縮微動脈阻力血壓牽張血管平滑肌舒張微動脈阻力血容量恢復可能和平滑肌細胞膜上的牽拉敏感性鈣通道有關。2021/8/1738muscle-derived mech

26、anism肌源性機制IV. Blood volume and long term regulation of blood pressure 血量和動脈血壓的長期調節 Neural regulation mainly plays a role in the regulation of BP under the condition of the transient fluctuation of BP ,and the blood volume is the major factor influencing the long term regulation of BP . 神經調節主要是在短時間內血

27、壓發生變化的情況下起 調節作用。動脈血壓長期調節的主要因素是血容量。 2021/8/1739IV. Blood volume and long termRenal-body fluid control system 腎-體液控制系統 (RAAS)The long term regulation of blood pressure is carrying out through the kidney to regulate the extracellular fluid volume, which is called Renal-body fluid control system .動脈血壓的長

28、期調節是通過腎臟調節細胞外液量來實現的。這種機制又稱為腎體液控制系統。 血容量血壓腎排水排Na+血壓恢復 血容量血壓腎排水排Na+血壓恢復2021/8/1740Renal-body fluid control systesaltEssential hypertension2021/8/1741saltEssential hypertension202 The efficacy of renal-body fluid control system to regulate the BP is determined by the influence of the fluctuation of BP to the excretion of sodium and water of kidney. 腎