醛固酮及心房间质重构与心房颤动关系的实验研究  

Effects of perindopril and spirolactone on plasma aldosterone and left atrial remodeling in a canine model of atrial fibrillation

作　　者：罗太阳[1] 刘小慧[1] 杜昕[1] 刘兴鹏[1] 雷涛[1] 王海云[1] 史加海[2] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029 [2]首都医科大学附属北京安贞医院心外科,100029

出　　处：《中华心血管病杂志》2009年第7期626-629,共4页Chinese Journal of Cardiology

摘　　要：目的探讨醛固酮（Aid）及心房间质重构与心房颤动（房颤）发生发展的关系。方法18只犬随机分为对照组（普通喂食）、培哚普利组（培哚普利1mg·kg^-1·d^-1）、螺内酯组（螺内酯10mg·kg^-1·d^-1），均置入起搏器并持续起搏8周。动态检测左心房的形态功能和血浆Ald水平，记录停止起搏后维持房颤的例数及持续的时间，处死动物后检测心房组织Ald水平及心房肌纤维化的情况。结果起搏前三组间血浆Ald水平差异无统计学意义（P〉0．05），而起搏4周及8周后培哚普利组、螺内酯组明显低于对照组（P〈0．05）；对照组起搏后4周及8周显著高于起搏前（P〈0．05），而培哚普利组、螺内酯组起搏前后差异无统计学意义（P〉0．05）。起搏4周及8周后，对照组左心房左右径、上下径、收缩末期容积和舒张末期容积较起搏前明显增大，而左房射血分数（LAEF）较起搏前显著降低（P〈0．05）；与对照组相比，培哚普利组、螺内酯组起搏后上述指标均明显减小，而LAEF显著增大（P〈0．05）。与对照组相比，培哚普利组、螺内酯组停止起搏后维持房颤犬明显减少，平均持续时间也明显短于对照组，而培哚普利组、螺内酯组之间差异无统计学意义。对照组左右心房肌胶原体积分数值明显高于培哚普利组、螺内酯组（P〈0．05），而培哚普利组、螺内酯组之间差异无统计学意义（P〉0．05）。结论在房颤发生发展中，血浆及心房肌Ald水平升高，心房肌纤维化加重，左房内径及容积会逐渐增大而收缩功能降低；螺内酯和培哚普利可抑制Ald水平升高及心房肌纤维化加重、改善心房结构及功能的变化、减少房颤的发生率及持续时间，且二者效果相似。Objective To investigate the effects of perindopril and spirolactone on plasma aldosterone （Ald） and left atrial remodeling and function in a canine model of atrial fibrillation （AF）. Methods Adult dogs were randomly assigned to receive normal diet （ group A）, perindopril （ group B, 1 mg· kg^-1 · d^-1） and spironolactone （group C, 10 mg · kg^-1 · d^-1, n =6 each） and rapid paced （500 beats/min） for 8 weeks. Plasma Aid levels as well as atrial dimension and function at baseline and at 4 and 8 weeks after pacing were measured by RIA and eehocardiography, respectively. Incidence of maintained AF and AF duration were recorded when pacing was stopped after 8 weeks of pacing. Left and right atrial tissues were collected for measurements of tissue Aid levels and fibrosis. Results Plasma Aid was similar among groups at baseline （ P 〉 0.05 ） and significantly increased post 4 and 8 weeks pacing in group A （ P 〈 0.05 ） while remained unchanged post pacing in group B and C （P 〉 0.05） compared to respective baseline level. Atrial Aid was significantly lower in group B and C compared that in group A post 8 weeks pacing （ P 〈 0.05）. Left atrial dimension, end-systolic and end-diastolic volume were significantly increased while left atrial ejection fraction （LAEF） was significantly reduced post pacing in group A （all P 〈0.05 vs. baseline） and thses changes were significantly attenuated in group B and C （P 〈 0. 05 vs. group A）. Incidence of maintained AF and AF duration post pacing as well as interstitial collagen volume fraction were significantly lower in group B and C compared those in group A （P 〈 0.05）. Conclusion Increased Ald might be an important pathogenesis for AF formation and progression, spironolactone and perindopril could attenuate atrial remodeling and improve atrial function by reducing plasma and tissue Aid levels in this model.

关 键 词：心房颤动 醛固酮 心房 纤维化 

分 类 号：R686[医药卫生—骨科学]