Publikationsserver der Universitätsbibliothek Marburg
Titel:Geschlechtsspezifische Unterschiede der hyperkapnischen Chemosensitivität bei lungengesunden Probanden über 60 Jahre
Autor:Schulze Lohoff, Barbara
Weitere Beteiligte: Becker, Heinrich (Prof. Dr.)
Veröffentlicht:2009
URI:https://archiv.ub.uni-marburg.de/diss/z2010/0262
DOI: https://doi.org/10.17192/z2010.0262
URN: urn:nbn:de:hebis:04-z2010-02622
DDC:610 Medizin
Titel (trans.):Gender differences in the hypercapnic chemosensitivity in healthy subjects over 60 years
Publikationsdatum:2010-05-04
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
HCVR, Hyperkapnische Chemosensitivität, Atemantwort, HCVR, Cheyne-Stokes-Atmung, ventilatory response, Cheyne-Stokes respiration, hypercapnic chemosensitivity, Hyperkapnie

Zusammenfassung:
Die hyperkapnische Chemosensitivität (HCVR) scheint eine entscheidende Rolle in der Genese der Cheyne-Stokes-Atmung bei herzinsuffizienten Patienten zu spielen. Für diese Atemform, welche vorwiegend in höherem Lebensalter auftritt, ist das männliche Geschlecht ein wesentlicher prädisponierender Faktor. Als Ursache hierfür wird eine bei Männern gegenüber Frauen der entsprechenden Altersklasse erhöhte hyperkapnische Chemosensitivität vermutet. Da Progesteron einen steigernden Effekt auf die hyperkapnische Chemosensitivität auszuüben scheint und bei Frauen im Rahmen der hormonellen Umstellungen in den Wechseljahren der Progesteronspiegel sinkt, ist es denkbar, dass auch die hyperkapnische Chemosensitivität in der Postmenopause relevant abnimmt. Systematische Untersuchungen der HCVR ausschließlich bei postmenopausalen Frauen und Männern gleichen Alters in einem großen Kollektiv liegen bisher allerdings nicht vor. Ziel dieser Arbeit war die Prüfung der Hypothese, dass bei postmenopausalen Frauen über 60 Jahre die hyperkapnische Chemosensitivität signifikant niedriger ist als bei altersgleichen Männern. Die hyperkapnischen Chemosensitivität wurde bei 51 Männern und 49 Frauen über 60 Jahre mittels Rückatmungstest nach Read gemessen. Hier wird ein hyperoxisches Gasgemisch mit einem initialen CO2-Anteil von 7% in ein geschlossenes System rückgeatmet. Es handelt sich hierbei um eine international gebräuchliche Standardmethode. Die hyperkapnische Atemantwort wird dabei als Änderung des Atemminutenvolumens pro Zunahme des endexspiratorischen CO2-Partialdrucks (∆AMV/∆ETCO2) gemessen. Es wurde für postmenopausale Frauen über 60 Jahre eine mit 1,22 ± 0,65 l/min/mmHg um nahezu 50% niedrigere hyperkapnische Atemantwort gemessen als für altersentsprechende Männer, die im Mittel eine HCVR von 2,15 ± 1,07 l/min/mmHg aufwiesen. Die aufgestellte Hypothese konnte somit bestätigt werden. Nach den Ergebnissen dieser Studie kann man die bei Frauen in der betroffenen Altersklasse erniedrigte hypercapnische Chemosensitivität gewissermaßen als Schutz vor dem Auftreten von Cheyne-Stokes-Atmung postulieren. Hier könnte sich in Zukunft ein Therapieansatz in Form der medikamentösen Reduktion der hyperkapnischen Chemosensitivität bei Männern ergeben.

Bibliographie / References

  1. JAVAHERI, S., PARKER, T.J., LIMING, J.D., CORBETT, W.S., NISHIYAMA, H., WEXLER, L. and ROSELLE, G.A., 1998. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation, 97(21), pp. 2154-2159.
  2. LEUNG, R.S., FLORAS, J.S. and BRADLEY, T.D., 2006. Respiratory modulation of the autonomic nervous system during Cheyne-Stokes respiration. Canadian journal of physiology and pharmacology, 84(1), pp. 61-66.
  3. Cerebral blood flow sensitivity to CO2 measured with steady-state and Read's rebreathing methods. Respiratory physiology & neurobiology, 137(1), pp. 1-10.
  4. SOLIN, P., ROEBUCK, T., JOHNS, D.P., WALTERS, E.H. and NAUGHTON, M.T., 2000. Peripheral and central ventilatory responses in central sleep apnea with and without congestive heart failure. American journal of respiratory and critical care medicine, 162(6), pp. 2194-2200.
  5. RICHTER, D.W., 2007. Atemregulation. In: R.F. SCHMIDT and F. LANG, eds, Physiologie des Menschen. Heidelberg: Springer Medizin Verlag, .
  6. STRELLER, T., HUCKSTORF, C., PFEIFFER, C. and ACKER, H., 2002. Unusual cytochrome a592 with low PO2 affinity correlates as putative oxygen sensor with rat carotid body chemoreceptor discharge. The FASEB journal : official publication of the Federation of American Societies for Experimental Biology, 16(10), pp. 1277- 1279.
  7. MATSUMOTO, A.M., SANDBLOM, R.E., SCHOENE, R.B., LEE, K.A., GIBLIN, E.C., PIERSON, D.J., BREMNER, W.J. 1985. Testosterone replacement in hypogonadal men: effects on obstructive sleep apnoea, respiratory drives, and sleep.
  8. TARKKILA, P., TUOMINEN, M. and LINDGREN, L., 1998. Comparison of respiratory effects of tramadol and pethidine. European journal of anaesthesiology, 15(1), pp. 64-68.
  9. READ, D.J., 1967. A clinical method for assessing the ventilatory response to carbon dioxide. Australasian Annals of Medicine, 16(1), pp. 20-32.
  10. LINTON, R.A., POOLE-WILSON, P.A., DAVIES, R.J. and CAMERON, I.R., 1973. A comparison of the ventilatory response to carbon dioxide by steady-state and rebreathing methods during metabolic acidosis and alkalosis. Clinical science and molecular medicine.Supplement, 42(2), pp. 239-249.
  11. JAVAHERI, S., 1999. A mechanism of central sleep apnea in patients with heart failure. The New England journal of medicine, 341(13), pp. 949-954.
  12. American journal of respiratory and critical care medicine, 165(9), pp. 1245-1250.
  13. MIYAMURA, M. and HONDA, Y., 1972. An assessment of cardiac output by the CO 2 method during exercise. Nippon seirigaku zasshi.Journal of the Physiological Society of Japan, 34(7), pp. 435-436.
  14. STEWART, D.A., GRUNDSTEIN, R.R., BERTHON-JONES, M., HANDELSMAN, D.J., SULLIVAN, C.E. 1992. Androgen blockade does not affect sleep-disordered breathing or chemosensitivity in men with obstructive sleer apnea.Am. Rev. Respir. Dis. 146 (6):1389-93.
  15. MODALEN, A.O., QUIDING, H., FREY, J., WESTMAN, L. and LINDAHL, S., 2006. A novel molecule with peripheral opioid properties: the effects on hypercarbic and hypoxic ventilation at steady-state compared with morphine and placebo. Anesthesia and Analgesia, 102(1), pp. 104-109.
  16. Apnea-hypopnea threshold for CO2 in patients with congestive heart failure.
  17. JENNETT, S, SHORT, H., 1973. Assessment of respiratory chemosensitivity by a rebreathing method. Brit. J. Anesth. 45, 119.
  18. JELKMANN, W., 2007. Atemgastransport. In: R.F. SCHMIDT and F. LANG, eds, Physiologie des Menschen. Heidelberg: Springer Medizin Verlag.
  19. SCHEID, P., 2005. Atmung. In: R. KLINKE, H.C. PAPE and S. SILBERNAGEL, eds, Physiologie. 5 edn. Stuttgart: Georg Thieme Verlag, pp. p. 255-324.
  20. KIMURA, H., HAYASHI, F., YOSHIDA, A., WATANABE, S., HASHIZUME, I. and HONDA, Y., 1984. Augmentation of CO2 drives by chlormadinone acetate, a synthetic progesterone. Journal of applied physiology: respiratory, environmental and exercise physiology, 56(6), pp. 1627-1632.
  21. READ, D.J. and LEIGH, J., 1967. Blood-brain tissue Pco2 relationships and ventilation during rebreathing. Journal of Applied Physiology, 23(1), pp. 53-70.
  22. YUMINO, D. and BRADLEY, T.D., 2008. Central sleep apnea and cheyne-stokes respiration. Proceedings of the American Thoracic Society, 5(2), pp. 226-236.
  23. Chemoreflex control of breathing during wakefulness in healthy men and women.
  24. NATTIE, E.E. and LI, A., 2002. CO2 dialysis in nucleus tractus solitarius region of rat increases ventilation in sleep and wakefulness. Journal of applied physiology (Bethesda, Md.: 1985), 92(5), pp. 2119-2130.
  25. NATTIE, E.E. and LI, A., 2001. CO2 dialysis in the medullary raphe of the rat increases ventilation in sleep. Journal of applied physiology (Bethesda, Md.: 1985), 90(4), pp. 1247-1257.
  26. LI, A., RANDALL, M. and NATTIE, E.E., 1999. CO(2) microdialysis in retrotrapezoid nucleus of the rat increases breathing in wakefulness but not in sleep.
  27. REGENSTEINER, J.G., WOODARD, W.D., HAGERMAN, D.D., WEIL, J.V., PICKETT, C.K., BENDER, P.R. and MOORE, L.G., 1989. Combined effects of female hormones and metabolic rate on ventilatory drives in women. Journal of applied physiology (Bethesda, Md.: 1985), 66(2), pp. 808-813.
  28. PROUT, W., 1811. Ebenda XV; übersetzt aus Thomson, Ann. of philos. II p. 328. , pp. p. 47.
  29. SEITZ, W., LUBBE, N., FRITZ, K., SYBRECHT, G. and KIRCHNER, E., 1985. Effect of tramadol on ventilatory CO2 response and mouth occlusion pressure. Der Anaesthesist, 34(5), pp. 241-246.
  30. SELG, E., LASTBOM, L., RYRFELDT, A., KUMLIN, M. and DAHLEN, S.E., 2008. Effects of selective and non-selective COX inhibitors on antigen-induced release of prostanoid mediators and bronchoconstriction in the isolated perfused and ventilated guinea pig lung. Prostaglandins, leukotrienes, and essential fatty acids, 78(2), pp. 89-97.
  31. Einfluß von Tramadol auf die ventilatorische CO2-Antwort und den Mundokklusionsdruck. Anaesthesist, 34, pp. 241-246.
  32. SIN, D.D., JONES, R.L. and MAN, G.C., 2000. Hypercapnic ventilatory response in patients with and without obstructive sleep apnea: do age, gender, obesity, and daytime PaCO(2) matter? Chest, 117(2), pp. 454-459.
  33. MOROZ, E.V., VERKHRATSKY, N.S., 1985. Hypophyseal-gonadal system during male aging. Arch. Gerontol. Geriatr., 4 (1985) 13-19
  34. NIEUWENHUIJS, D., BRUCE, J., DRUMMOND, G.B., WARREN, P.M. and DAHAN, A., 2001. Influence of oral tramadol on the dynamic ventilatory response to carbon dioxide in healthy volunteers. British journal of anaesthesia, 87(6), pp. 860-865.
  35. WHITE, D.P., SCHNEIDER, B.K., SANTEN, R.J., MCDERMOTT, M., PICKETT, C.K., ZWILLICH, C.W., WEIL, J.V. 1985. Influence of testosterone on ventilation and chemosensitivity in male subjects. J. Appl. Physiol. 59 (5): 1452-7.
  36. RIGG, J.R.A,INMAN, E.M., SAUNDERS, N.A., LEEDER, S:R:, JONES, N.L., 1977. Interaction of mental factors with hypercapnic ventilatory drive in man. Clin. Sci. Mol. Med. , 52: 269-275..
  37. Interaction of metabolic and behavioral respiratory control during hypercapnia and speech. Am. Rev. Resp. Dis., 117: 903-909.
  38. LEITCH, A.G., CLANCY, L. and FLENLEY, D.C., 1975. Maximal oxygen uptake, lung volume and ventilatory response to carbon dioxide and hypoxia in a pair of identical twin athletes. Clinical science and molecular medicine, 48(3), pp. 235-238.
  39. JENNETT, S, 1978. Methods of studying the control of breathing in experimental animals and man. Pharmacy Therapy, B, Vol. 3. Edited by J. Widdicombe. Elmsford, N.Y., Permagon Press, pp. 618-716.
  40. JONES, R.L., NEARY, J.M. and RYAN, T.G., 1993. Normal values for the hypercapnic ventilation response: effects of age and the ability to ventilate. Respiration; international review of thoracic diseases, 60(4), pp. 197-202.
  41. SCHMIDT, V. , 2001. Normwerte der hypoxischen und hyperkapnischen Atemantwort. Marburg: Philipps-Universität (Dissertation).
  42. JANSSENS, J.P., PACHE, J.C. and NICOD, L.P., 1999. Physiological changes in respiratory function associated with ageing. The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology, 13(1), pp. 197-205.
  43. LANFRANCHI, P.A., BRAGHIROLI, A., BOSIMINI, E., MAZZUERO, G., COLOMBO, R., DONNER, C.F. and GIANNUZZI, P., 1999. Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure. Circulation, 99(11), pp. 1435-1440.
  44. STRACHOVA, Z, PLUM, F 1973 Reproducibility of the rebreathing carbon dioxide test using an improved method. Am. Rev. Resp. Dis, 107, pp864-869.
  45. LANDMESSER, C.M., COBB, S., PECK, A.S. and CONVERSE, J.G., 1957. Respiratory responses to carbon dioxide transients in normal volunteers. Anesthesiology, 18(6), pp. 807-830.
  46. SIN, D.D., FITZGERALD, F., PARKER, J.D., NEWTON, G., FLORAS, J.S. and BRADLEY, T.D., 1999. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. American journal of respiratory and critical care medicine, 160(4), pp. 1101-1106.
  47. NAUGHTON, M., BENARD, D., TAM, A., RUTHERFORD, R. and BRADLEY, T.D., 1993. Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure. The American Review of Respiratory Disease, 148(2), pp. 330-338.
  48. NAUGHTON, M.T., 2007. Testing for Cheyne-Stokes respiration in patients with heart failure: while sleeping or cycling? Chest, 132(5), pp. 1416-1418.
  49. The influence of body size on the ventilatory response to hypercapnia. The Japanese journal of physiology, 35(1), pp. 169-174.
  50. MCGURK, S.P., BLANKSBY, B.A. and ANDERSON, M.J., 1995. The relationship of hypercapnic ventilatory responses to age, gender and athleticism. Sports medicine (Auckland, N.Z.), 19(3), pp. 173-183.
  51. LEINO, K., MILDH, L., LERTOLA, K., SEPPALA, T. and KIRVELA, O., 1999. Time course of changes in breathing pattern in morphine-and oxycodone-induced respiratory depression. Anaesthesia, 54(9), pp. 835-840.
  52. MARINO, P.L., 2008. Transport von Sauerstoff und Kohlendioxid. In: P.L. MARINO, Das ICU-Buch: Praktische Intensivmedizin.
  53. Ventilatory response and pattern of breathing during hypercapnia. Bulletin europeen de physiopathologie respiratoire, 22(1), pp. 21-26.
  54. Ventilatory responses to hypercapnia and hypoxia during continuous aspirin ingestion. Journal of applied physiology: respiratory, environmental and exercise physiology, 43(6), pp. 971-976.
  55. NATTIE, E.E., 2001. Central chemosensitivity, sleep, and wakefulness. Respiration physiology, 129(1-2), pp. 257-268.
  56. PUTNAM, R.W., FILOSA, J.A. and RITUCCI, N.A., 2004. Cellular mechanisms involved in CO(2) and acid signaling in chemosensitive neurons. American journal of physiology.Cell physiology, 287(6), pp. C1493-526.
  57. The influence of indomethacin on the ventilatory response to CO2 in newborn anaesthetized piglets. The Journal of physiology, 477 ( Pt 2)(Pt 2), pp. 339-345.
  58. LADD, L.A., KAM, P.C., WILLIAMS, D.B., WRIGHT, A.W., SMITH, M.T. and MATHER, L.E., 2005. Ventilatory responses of healthy subjects to intravenous combinations of morphine and oxycodone under imposed hypercapnic and hypoxaemic conditions. British journal of clinical pharmacology, 59(5), pp. 524- 535.
  59. MACDONALD, M., FANG, J., PITTMAN, S.D., WHITE, D.P. and MALHOTRA, A., 2008. The current prevalence of sleep disordered breathing in congestive heart failure patients treated with beta-blockers. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 4(1), pp. 38-42.
  60. KRONENBERG, R.S. and DRAGE, C.W., 1973. Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal men. The Journal of clinical investigation, 52(8), pp. 1812-1819.
  61. Cheyne-Stokes respiration in patients hospitalised for heart failure. Respiratory research, 5, pp. 14.

* Das Dokument ist im Internet frei zugänglich - Hinweise zu den Nutzungsrechten
© UB Marburg 1997 - 2024 Universitätsbibliothek Marburg