目的 本研究主要探讨胃转流术通过拮抗过度激活的交感系统缓解高血压和心血管功能紊乱的机制。
方法 高血压合并代谢紊乱的患者接受腹腔镜胃旁路手术,自发性高血压大鼠接受胃转流术或假手术。手术病人检测在基线和随访中的血压、心率、内皮依赖的血管舒张等实验参数。自发性高血压大鼠术后检测血压心率对冷应激的反应,肾交感神经活性,电场刺激引起的血管收缩,孤束核的微量注射，心血管功能和结构等改变。
结果 与术前相比,术后高血压患者和大鼠血压和心率均显著降低。高血压患者受损的内皮依赖性血管舒张功能和代谢紊乱在手术后得到改善。自发性高血压大鼠术后心血管紊乱被逆转。急性冷刺激下,手术组大鼠血压心率变化均显著小于假手术组。手术组大鼠在肾脏交感神经活性和血管周围神经刺激引起的血管收缩以及孤束核介导的血压变化均显著低于假手术组。体重降低并不影响假手术组大鼠的血压和肾脏交感神经活性。
结论 胃肠道干预可以通过拮抗过度激活的交感系统改善高血压患者和自发性高血压大鼠的血压，因此，针对胃肠道的干预可能成为一个治疗高血压和代谢紊乱的新的靶点。

Objective  We investigated the hypothesis that the favorable effects of gastrointestinal intervention on hypertension and cardiovascular disturbances are mediated by antagonizing overdrive of the sympathetic nervous system (SNS).
Methods Hypertensive patients with metabolic disturbances underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery, and spontaneously hypertensive rats (SHR) underwent RYGB or sham surgery. Blood pressure (BP), heart rate (HR), endothelium-dependent flow-mediated dilation, and anthropometric as well as laboratory parameters were measured at baseline and during follow-up. Changes of BP and HR in response to cold stress, renal sympathetic nervous activity (RSNA), vasoconstriction induced by electrical field stimulation, microinjection of nucleus of the solitary tract (NTS) and cardiovascular function and structure were examined in SHR with or without surgery.
Result Compared with baseline, BP and HR were significantly reduced in both hypertensive patients with type 2 diabetes and rats. Impaired endothelial dependent vasodilatation and metabolic disturbances in hypertensive patients were also ameliorated after surgery. Cardiovascular disturbances were reversed by surgery in SHR. Under acute cold exposure, the variations in BP and HR were smaller in surgically treated SHR compared with sham SHR. RSNA and vasoconstriction induced by perivascular nerve stimulation as well as NTS mediated changes of BP were decreased in surgically treated SHR compared with sham SHR. Weight loss did not affect BP and RSNA in sham SHR.
Conclusions Gastrointestinal intervention ameliorates hypertension in both hypertensive patients and rats by inhibiting overdrive of the SNS. Therefore, targeting gastrointestine could be a novel strategy to treat hypertension with metabolic disturbances.