犬心房与肺静脉交感神经分布与阵发性心房颤动的关系  

The relationship of paroxysmal atrial fibrillation and regional sympathetic innervations in the atria and pulmonary veins:experiment with dogs

作　　者：易忠[1] 张海澄[1] 张萍[1] 刘刚[2] 刘鹏[1] 孙健玲[1] 刘斌[1] 郭继鸿[1] 

机构地区：[1]北京大学人民医院心内科,100044 [2]北京大学人民医院心外科,100044

出　　处：《中华医学杂志》2007年第48期3433-3435,共3页National Medical Journal of China

基　　金：国家自然科学基金(30471710);北京市自然科学基金(7032030);首都医学发展科研基金(20023036)

摘　　要：目的探讨犬交感神经末梢在心房与肺静脉分布的特点及其与房颤诱发的相关性。方法 16只健康杂种犬,全麻、左右侧开胸。刺激双侧迷走交感干,分别于右心耳、左心耳、左心房及四支肺静脉行 S_1S_1猝发刺激及 S_1S_2程序刺激,观察心房及肺静脉不同部位房颤的诱发率。随后,处死动物,行心房、肺静脉交感神经抗酪氨酸羟化酶(TH)抗体染色,计算心房及肺静脉各部位交感神经密度,比较交感神经密度与房颤诱发之间的关系。结果 14只犬完成全部试验。除右下肺静脉房颤诱发率较低外,余各部位房颤诱发率无明显差异;心房和心耳 TH 染色阳性的神经密度分别为高于肺静脉内的神经密度[(128±65)/mm^2,(76±29)/mm^2,P=0.02];能诱发房颤的犬的 TH 染色阳性的神经密度高于未能诱发房颤(P>0.05)。结论心房、心耳的交感神经分布比肺静脉的交感神经分布的密度大;房颤诱发与心房和肺静脉内交感神经分布的密度有一定关系。Objective To test the hypothesis that regional sympathetic innervation in the atria and pulmonary veins are correlated with atrial fibrillation （AF）. Methods Sixteen adult mongrel dogs underwent thoracotomy under general anesthesia. Bilateral cervical vagal trunks were decentralized. Multipolar catheters were placed into right atrial appendage （RAA）, left atrial appendage （LAA）, left atrium （LA）, left superior pulmonary vein （LSPV）, left inferior pulmonary vein （LIPV）, right superior pulmonary vein （RSPV） , and left inferior pulmonary vein （LIPV）. The bilateral sympathovagal trunks were stimulated, S1S1 burst stimulation and S1S2 stimulation procedure were performed on different points of RAA, LAA, LA, LSPV, LIPV, RSPV, and LIPV. The TF thus induced was monitored. After that, the dogs were killed with their hearts and lungs were taken out. Immunocytochemical staining of cardiac nerves was performed using anti-tyrosine hydroxylase （TH） antibodies. The nerve fiber density was counted manually for each case and expressed as the mean number per slice. Results Two dogs died during the experiment and the whole procedure was completed on 14 dogs. There was no significant difference in the AF induction rate among the most points, however, the AF induction rate of the RIPV was significantly lower than those of the other points （ all P 〈 0.05 ）. The levels of density of TH-positive nerves in the atria and atrial appendages were significantly higher than those in the pulmonary veins （ P = 0.02 ）. The density of TH-positive nerves in the dogs with AF was significantly higher than that in the dog without AF （ P 〈 0.05 ）. The innervation of sympathetic nerves in atria and pulmonary veins was highly correlated to the induction of atrial fibrillation （r = 0.83 ）. Conclusion Regional sympathetic hyperinnervation plays an important role in atrial fibrillation induction.

关 键 词：交感神经系统 心房颤动 

分 类 号：R541.75[医药卫生—心血管疾病]