肾去交感神经对犬心房基质和心房颤动诱发的影响  

Effect of Renal Sympathetic Denervation on the Atrial Substrate and Inducibility of Atrial Fibrillation

作　　者：代子玄[1] 于胜波[1] 邹明辉[1] 王徐乐[1] 肖金平[1] 赵庆彦[1] 黄从新[1] 

机构地区：[1]武汉大学人民医院心内科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2014年第2期169-173,共5页Medical Journal of Wuhan University

基　　金：国家科技支撑计划项目(编号:2011BAI11B12);国家自然科学基金资助(编号:81070144)

摘　　要：目的:探讨经导管消融肾交感神经对犬心房基质和心房颤动(房颤)诱发的影响。方法:13只犬随机分为对照组(7只犬)和消融组(6只犬),对照组犬快速心房刺激(800次/min)7h,每小时中断一次监测心房有效不应期(AERP)和房颤诱发。7h刺激前、后分别取静脉血检测血管紧张素Ⅱ(AngⅡ)及醛固酮水平;消融组犬先行双侧经皮介入肾动脉消融,喂养6周后心房快速刺激、AERP监测和房颤诱发同对照组。肾动脉消融前、6周后、7h刺激后分别取静脉血检测AngⅡ及醛固酮水平。两组犬取心房和肺静脉组织,检测神经分布密度、Cx43蛋白和心钠肽的水平。结果:对照组和消融组在心房快速刺激后AERP均明显缩短,两组间无明显差别;快速刺激7h后,对照组房颤诱发平均时间及平均次数均明显高于消融组;消融组右心房心钠肽水平明显低于对照组(pg/mg)[(220.5±37.6)比(164.4±22.0),P=0.02];消融组犬左心房、右心房和肺静脉Cx43蛋白表达均明显低于对照组(0.52,0.63,0.87比1,1.05,1.91,P<0.05)。结论:肾去交感神经可降低短时心房快速刺激房颤的诱发,其机制可能与肾去交感神经后心房基质改变有关。Objective： To investigate the effect of renal sympathetic denervation on atrial substrate and inducibility of atrial fibrillation （AF）. Methods： Thirteen dogs were used for the study as follows： control group （7 dogs） and renal artery ablation （RAA） group （6 dogs）. In control group, dogs were subjected to atrial pacing at 800 beats/min for 7 hours. Atrial effective refractory period （AERP） and induced AF were measured every hour in the status of non-pacing. Blood samples were collected before and after pacing to measure the levels of angiotensin（Ang） ]1 and aldosterone. In RAA group, each renal artery was ablated, and after six weeks, the procedure of pacing and electrophysiological measurement was nearly the same as in the control group. Blood samples were collected before ablation, before pacing and 7 hours after pacing. After electrophysiological measurement, densities of autonomic nerve, Cx43 and atrial natriuretic peptide （ANP） in pulmonary veins （PVs） and atrial tissues were measured. Results： There was a persistent decrease in AERP in both groups. However, after cessation of pacing for 7 hours, induced times and duration of AF was higher in control group than that respectively in RAA group. Levels of ANP in right atrium were lower in RAA group than in control group （pg/mg） （ANP： 220.5±37.6 υs 164.4±22.0, P=0.02）. Densities of Cx43 in RA, LA and PVs were lower in RAA group than those respectively in control group （0.52, 0.63, 0.87 υs 1, 1.05, 1.91, P〈0.05）. Conclusion： RAA can inhibit episodes of AF during short-time rapid atrial pacing. The mechanisms might have relationship with changes of atrial substrate after RAA.

关 键 词：心房颤动 肾交感神经 消融 肾素-血管紧张素-醛固酮系统 

分 类 号：R541.75[医药卫生—心血管疾病]