乙酰胆碱对人房颤心房肌电生理特性的影响  

Effect of acetylcholine on electrophysiological characteristics of human atrial myocytes from patients with atrial fibrillation

作　　者：周元[1] 刘金平[2] 连亦田[1] 董念国[2] 程龙献[1] 孙宗全[2] 刘坤[1] 王玉[3] 

机构地区：[1]华中科技大学同济医学院附属协和医院心血管内科,武汉430022 [2]华中科技大学同济医学院附属协和医院心血管外科,武汉430022 [3]华中科技大学同济医学院生物化学教研室

出　　处：《中华实验外科杂志》2011年第10期1753-1755,共3页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金资助项目（30700747）.

摘　　要：目的观察房颤时人心房肌细胞动作电位变化及迷走神经递质乙酰胆碱（ACh）对离体人心房肌动作电位（AP）及有效不应期（ERP）的影响。方法选择20例心脏瓣膜病患者分为两组，其中11例合并房颤者为房颤组（AF），9例窦性心律者为对照组（SR），术中取右心耳组织，采用玻璃微电极技术，检测两组患者静息膜电位（RMP），动作电位复极达90％的时程（APD90），动作电位复极达50％的时程（APD50）及不同起搏频率下APD90的变化，同时观察给予Ach前后上述指标的变化。结果Ach灌注前，AF组与SR组间RMP（63．70±3．00）mV比（54．70±2．19）mV、APD90（312．60±11．92）ms比（406．30±14．61）ms、APD50（177．30±14．05）ms比（218．50±15．10）ms差异有统计学意义（P〈0．05）。Ach灌注后，AF与sR两组间RMP（67．8±2．0）mv比（61．4±1．8）mV、APD90（263．60±13．38）ms比（316．20±15．40）ms、APD50（173．60±16．82）ms比（217．60±15．16）ms差异有统计学意义（P〈0．05）。与灌注前自身比较，两组RMP显著增高、APD90显著缩短（P〈0．05）。APD50差异无统计学意义（P〉0．05）。但在AF组患者，其APD90缩短程度（AAPD90，％）较SR组1h（P〈0．05）。结论房颤时存在心房组织APD缩短，频率适应性降低等电重构，它促进了房颤的维持。Aeh可加重重构作用，但在慢性房颤中这种作用减弱。这种改变可能是机体对抗房颤的一种调节机制。Objective ＂Tostudy the changes of action potential （AP） of atrial myocytes from pa- tients with chronic atrial fibrillation （AF） and the electrophysiological effects of acetylcholine （Ach） on AP and effective refractory period （ERP） of atrial myocytes from AF patients. Methods Right atrial appendages were obtained from 11 patients with chronic AF and 9 patients matched as controls with sinus rhythm （SR）. All patients were subjected to valve replacement surgery. Rest membrane potential （RMP）, 50% and 90% action potential duration （APDSO, APD90） of human atrial myocytes were recorded before and after administration of Ach by using standard intracellular microelectrode technique. APD90 and APDSO were also measured in different pacing rate. Results Before perfusion with Ach, RMP of atrial myocytes from patients with AF was more negative than in SR patients [ （63.70 ± 3.00） mV vs. （54.70 ± 2. 19） mV], P 〈 0. 05. APD90 and APD50 in AF patients were shorter than in SR patients [ APD90 （312.60±11.92） msvs. （406.30±14.61） ms], APD50 （177.30±14.05） msvs. （218.50±15.10） ms,P 〈0. 05]. Ach （ 10μmol/L） made RMP more negative [ （67.8 ±2. 0） mV vs. （61, 4 ±.8） mV] and shortened APD90 [ （263.60 ±13.38） ms vs. （316. 20±15.40） ms], APDSO [ （ 173.60 ± 16. 82） ms vs. （217. 60±15. 16） ms] in both groups,P 〈0. 05. APD50 had no significant change after perfusion with Ach, but the alterations of RMP and APD90 were more significant than those before perfusion respectively （P 〈 0. 05）. The change of APD90 in SR patients is more remarkable than that in AF patients （P 〈 0. 05）. Conclusion Patients with atrial fibrillation has the obvious decrease of frequency adaptation and more shortened APD, which contribute to the development and maintenance of atrial fibrillation. But it is not marked that these changes have been aggravated by Ach in patients with AF. Because the effect of Ach is decreased in these patients, this is possibly a

关 键 词：房颤 乙酰胆碱 动作电位 频率适应性 电生理 

分 类 号：R541.7[医药卫生—心血管疾病]