不同次数心室颤动后肿瘤坏死因子α和脑钠肽的变化与除颤阈值的相关性  

The dynamic alteration of tumor necrosis factor-α and type B natriuretic peptide following a various episodes of short duration ventricular fibrillation and the relationship with defibrillation threshold in canine

作　　者：任淑静[1] 金奇[1] 张凝[1] 凌天佑[1] 庞旸[1] 林长坚[1] 周建[1] 陈颖[1] 顾刚[1] 沈永初[1] 吴立群[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心脏科,上海20002

出　　处：《中国心脏起搏与心电生理杂志》2011年第2期142-145,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金项目(项目编号:81070266;81000081);上海市科委课题(项目编号:08140900600;10140903100);上海高校创新团队发展计划资助

摘　　要：目的探讨犬单次短时间心室颤动(SDVF)和多次SDVFs后体内肿瘤坏死因子α(TNF-α)及脑钠肽(BNP)的变化及其与除颤阈值(DFT)的关系。方法将144道(12×12,间距2 mm)自制电极片缝至比格犬(n=7)左室前侧壁,用于心外膜刺激和电生理标测。通过心外膜电极行30次快速脉冲(30 Hz)刺激诱发心室颤动(VF)。经颈内静脉置入除颤电极,每次VF持续20 s后给予除颤,用能量递增、递减方法测定DFT。分别于基础状态下,开胸后30 min,第一次SDVF后5 min和多次SDVFs后留取动脉血。ELISA法测定血浆TNF-α及BNP的浓度。评估VF后TNF-α和BNP短时间内的变化,以及与DFT的关系。结果基础状态与开胸后TNF-α和BNP浓度无差异。与基础状态相比,第一次SDVF后血中BNP(78±12.2μg/L vs 90±4.3μg/L,P=0.031)及TNF-α(547±104 ng/L vs 661±151 ng/L,P=0.036)浓度显著降低。多次SDVFs(3.43±0.73次)后,BNP及TNF-α水平有升高趋势,但与基础状态、单次SDVF后相比均无差异。DFT前血浆BNP水平与DFT呈正相关(r=0.76,P=0.046)。结论单次SDVF后,血浆TNF-α及BNP浓度降低,多次SDVFs后两者浓度无明显变化。DFT前BNP水平与DFT呈正相关,提示心功能受损可能导致DFT升高。Objective To investigate the alteration of tumor necrosis factor α（TNF-α） ＆ type B natriuretic peptide （BNP） following a single and multi episodes of short duration ventricular fibrillation （ SDVF）, and test the relationship between BNP, TNF-α and defibrillation threshold （DFT） in canine. Methods A custom epicardial electrode plaque which contains 144 （ 12 × 12, 2 mm spacing） tmipelar electrodes was sutured on the left ventriealar epieardium of 7 dogs＇ hearts. 30 times 30 Hz burst stimuli were given to induce ventrieular fibrillation（VF） through the electrode in the plaque. A catheter with the cathode in the right ventricle apex and the anode in the superior vena cava was inserted for defibrillation. The DFT was determined by an up-down algorithm after VF lasted for 20 s. Blood samples were taken from the femoral artery at baseline, after open-chest, at 5min following a single SDVF （20 s）, and after multi episodes of SDVFs. The blood eoneantrations of BNP and TNF-α were measured by ELISA. The relationships among BNP, TNF-α and DFT were evaluated. Results There was no significant difference between baseline and after open-chest in the concantration of BNP and TNF-α. Compared to baseline, BNP （78 ± 12.2 μg/L vs 90 ±4.3 μg/L, P =0.031 ） and TNF-α （547 ± 104 ng/L vs661 ± 151 ng/L, P =0.036） significantly decreased after the first episode of SDVF. Compared with a single SDVF, BNP and TNF-α did no significantly change foUowing multi episodes of SDVFs （ 3.43 ± 0.73 times ）. BNP had the positive correlation with DFT （ r = 0. 76, P = 0. 046）. Conclusion BNP and TNF-α decrease after a single SDVF, but there is no significant increase following multiepisodes of SDVFs. BNP has the positive correlation with DFT, which suggests that impaired cardiac function could cause the increase of DFT.

关 键 词：心血管病学 心室颤动 脑钠肽 肿瘤坏死因子-Α 除颤阈值 心功能 

分 类 号：R541.71[医药卫生—心血管疾病]