星状神经节刺激诱发急性心房颤动及心房电重构与神经重构  

Acute atrial fibrillation induced by stellate ganglion electrical stimulation and its mechanism of electri. cal remodeling and autonomic neural remodeling

作　　者：周祁娜[1] 陈冰心[1] 刘希[3] 徐晓霞[1] 郭玉君[1] 段明军[2] 季萌[1] 王红丽[1] 侯月梅[1] 

机构地区：[1]新疆医科大学第一附属医院心内科,乌鲁木齐830054 [2]新疆医科大学实验动物科学研究部,乌鲁木齐830054 [3]新疆医科大学自治区中医医院心功能科

出　　处：《中华心律失常学杂志》2013年第2期143-148,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：基金项目：国家国际科技合作专项（2011DFA32860）,新疆医学动物模型研究重点实验室开放课题（XJDX1103-2011-07）

摘　　要：目的探讨星状神经节（SG）刺激诱发急性心房颤动（房颤）及心房电重构与神经重构的机制。方法将健康家犬12只（18～25kg）随机分为2组：对照组（n=6），单纯快速心房起搏（RAP）；SG组（n=6），左侧或右侧SG刺激＋RAP。测定房颤诱发率、房颤持续时间，观察心房电重构和神经重分布。结果①与基础值相比，SG刺激显著增高房颤诱发率（P〈0．05），并延长房颤持续时间（P〈0．05）；（2）SG组有效不应期（ERP）显著缩短（P〈0．05），ERP离散度显著增加（P〈0．05），ERP频率适应性不良（P〈0．05）；③SG组心肌组织酪氨酸羟化酶（TH）、胆碱乙酰转移酶（ChAT）和生长相关蛋白-43（GAP-43）阳性神经纤维密度均高于对照组（P〈0．05）。结论SG刺激使心房和肺静脉部位的房颤诱发率升高，房颤持续时间延长，单侧去SG支配可减少房颤的发生和维持。交感神经活动增强可以引起心房和肺静脉发生电重构以及心房自主神经重构，急性心房电重构和急性自主神经重分布之间的恶性循环，是房颤早期诱发和维持的重要机制。Objective To explore the mechanism of electrical remodeling and autonomic neural remodeling in acute atrial fibrillation （AF） induced by stellate ganglion. Methods Twelve adult mongrel dogs weighing 18 to 25 kg were randomly divided into 2 groups. Control group （ n-= 6 ） underwent 6-hour rapid atrial pacing only. SG group（n=6） underwent 6-hour stellate ganglion（SG） stimulation plus rapid atrial pacing. AF induction rate, AF duration, ERP, dERP and ERP rate-adaption in left atrium （ LA）, right atrium （ RA ）, left superior pulmonary vein（LSPV） and left inferior pulmonary vein （LIPV） sites were measured. The density of TH, ChAT,GAP-43 positive nerve in RA and LA were detected by immunohistochemistry staining. Results （1）The induction rate of AF was significantly increased in SG group （P〈0. 05 ） , compared with baseline. The duration of AF was significantly prolonged in SG group（ P〈0. 05 ）, compared with baseline. （2）In SG group, ERP was signif- icantly shortened （ P〈0.05 ）, dERP was significantly increased （ P〈0. 05 ）, ERP rate-adaption was significantly decreased,compared with baseline. （3）SG stimulation produced greater increase of the density of TH, CHAT, GAP-43 positive nerve than without SG stimulation （P〈0. 05 ）. Conclusions Stellate ganglion stimulation promoted AF induction and prolonged AF maintenance in atrial and pulmonary sites. The inhibition sympathetic nerve activation by unilateral stellate ganglionectomy can reduce the AF initiating and sustaining. Acute atrial electrical remodeling and acute autonomic neural remodeling may form a vicious cycle in which each perpetuates the other, thereby initiating and sustaining AF. This vicious cycle may help to explain how AF maintains itself in its very early stage.

关 键 词：心房颤动 交感神经 星状神经节 重构 

分 类 号：R541[医药卫生—心血管疾病]