犬肾去交感神经对长期快速心房起搏后心房重构的影响  

Effect of Renal Sympathetic Denervation on the Atrial Remodeling in Ambulatory Canines of Prolonged Atrial Pacing

作　　者：王徐乐[1] 赵庆彦[1] 肖金平[1] 代子玄[1] 于胜波[1] 唐艳红[1] 黄鹤[1] 黄从新[1] 

机构地区：[1]武汉大学人民医院心内科/武汉大学心血管病研究所,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2014年第2期165-168,共4页Medical Journal of Wuhan University

基　　金：中央高校基本科研业务费专项资金资助(编号:2012302020210);国家科技支撑计划项目(编号:2011BAI11B12);国家自然科学基金资助项目(编号:81070144)

摘　　要：目的:探讨犬肾去交感神经对长期快速右心房起搏后心房重构的影响。方法:20只杂种犬经右侧颈外静脉途径植入高频率心脏起搏器,分为假手术组、右心房起搏(RAP)组、肾去交感神经(RSD)组。所有犬在试验基线期和终点取静脉血检测醛固酮水平;处死动物后迅速取左右心房组织,检测心房利钠肽(ANP)、肿瘤坏死因子-α(TNF-α)和白细胞介素(IL-6),缝隙连接蛋白40(Cx40)、缝隙连接蛋白43(Cx43)及神经密度水平。结果:右心房快速起搏5周后,与假手术组相比,RAP组犬血清醛固酮水平明显增加(P<0.05);与RAP组相比,RSD组犬血清醛固酮显著减少(P<0.05)。与假手术组相比,RAP组和RSD组左心房的ANP、TNF-α和IL-6水平,Cx40蛋白表达及交感神经密度(TH表达水平)和生长的神经纤维密度(GAP43表达水平)均明显增加(P<0.05);与RAP组相比,肾去交感神经可显著抑制右心房快速起搏引起的ANP、TNF-α、IL-6、Cx40及TH和GAP43阳性的神经密度等的升高(P<0.05)。结论:肾去交感神经可抑制长期快速右心房起搏后的心房重构。Objective： To investigate the effect of renal sympathetic denervation （RSD） on atrial remode ling after prolonged atrial pacing in ambulatory canines. Methods： Twenty mongrel dogs were im planted with a high frequency cardiac pacemaker, and were divided into three groups： sham-operated group （n=6）, right atrial pacing （RAP） group （n=7）, and RSD group （n=7）. Sham-oper ated group dogs were only implanted with pacemakers without pacing. In RSD group dogs, a pacemaker was implanted 6 weeks after RSD was performed bilaterally for recovery. Atrial pacing was maintained for 5 weeks in both RAP group and RSD group. The plasma level of aldosterone were measured in all the animals at the baseline and endpoint of the protocol. Then the heart was quickly excised and tissue specimens were obtained from the left and right atrium for test. Results： The plasma level of aldosterone were increased in both RAP group and RSD group at theendpoint of the protocol as compared with the baseline. Furthermore, the plasma level of aldosterone were significantly increased in RAP group compared with sham-operated group, but the increasing trend was inhibited in RSD group compared with RAP group （P〈0.05）. Similarly, RSD suppressed the increasing trend of ANP, TNF-α, and IL-6 levels produced by prolonged RAP. Compared with the sham-operated group, the RAP group had significantly increased levels of Cx40 （P〈0.05）, whereas RSD markedly reduced the upregulation of Cx40 expression as compared with the RAP group （P〈0.05）. Immunohistochemistry results showed that the densities of TH- and GAP43- positive nerves were significantly elevated in the RAP group as compared with the sham-operated group, while RSD operation significantly inhibited these changes produced by chronic RAP. Conclusion： Catheter-based renal denervation could suppress atrial remodeling, including the significantly increased atrial inflammation and gap junctional remodeling, together with atrial neural remodeling that are produced by

关 键 词：心房颤动 肾交感神经 消融 心房重构 

分 类 号：R541.7[医药卫生—心血管疾病]