肾交感神经去除术对心肌肥厚和心肌纤维化的影响  

Effect of renal sympathetic denervation on cardiac hypertrophy and fibrosis

作　　者：王强[1] 马双陶[1] 杨大春[1] 张彦[1] 李德[1] 唐兵[1] 杨永健[1] 

机构地区：[1]成都军区总医院心血管内科,四川成都610083

出　　处：《中国病理生理杂志》2014年第11期1993-1997,共5页Chinese Journal of Pathophysiology

基　　金：全军医学科技青年培育项目(No.13QNP058)

摘　　要：目的:观察肾交感神经去除术(renal sympathetic denervation,RDN)对心肌肥厚和心肌纤维化的影响,并探讨其可能机制。方法:选用12周龄的健康SD雄性大鼠60只,随机分为假手术组、假手术+RDN组、主动脉缩窄组、主动脉缩窄+RDN组,8周后用介入生理记录仪检测血流动力学和心功能指标,HE染色、苦味酸-天狼星红染色分别观察心肌肥厚和心肌纤维化情况,放射免疫分析法测量血浆肾上腺素浓度、肾素活性、血管紧张素II浓度及心脏血管紧张素II含量。结果:与主动脉缩窄组相比,RDN可显著改善主动脉缩窄大鼠心脏舒张功能[左室舒张末期压力(LVEDP):(8.03±1.66)mm Hg vs(15.77±2.14)mm Hg;等容舒张期左室压力下降最大速率(-dp/dt):(7 793±587)mm Hg/s vs(6 353±475)mm Hg/s;P<0.01]、防止其心肌肥厚和纤维化[左心室重量指数:3.340±0.121 vs 4.244±0.102;心肌细胞面积:(332.9±28.9)μm2vs(401.6±33.2)μm2;胶原容积分数:7.76%±0.85%vs 12.48%±1.82%;P<0.01]。然而,RDN不能降低主动脉缩窄大鼠的血压(P>0.05)。RDN导致主动脉缩窄大鼠的血浆肾上腺素浓度、肾素活性、血管紧张素II浓度及心脏血管紧张素II含量均明显减少(P<0.01)。结论:RDN可以通过降低交感和肾素-血管紧张素系统活性直接抑制心肌肥厚和心肌纤维化,从而改善心脏功能。AIM： To investigate the effect of renal sympathetic denervation（ RDN） on cardiac hypertrophy and fibrosis and to explore the underlying mechanisms. METHODS： Male SD rats were randomly divided into 4 groups： sham,sham plus RDN,aortic constriction（ AC） and AC plus RDN group（ n = 15 for each group）. After the intervention for 8weeks,the haemodynamic data and cardiac function were measured by a physiological recorder. The histological structure of the heart was evaluated by HE and picro-sirius red staining. The plasma concentration of norepinephrine（ NE）,renin activity,angiotensin II（ Ang II） concentration and cardiac Ang II level were determined by radioimmunoassay. RESULTS： Compared with AC group,RDN improved cardiac diastolic function [left ventricular end-diastolic pressure：（ 8. 03 ± 1. 66） mm Hg vs（ 15. 77 ± 2. 14） mm Hg;- dp/dt：（ 7 793 ± 587） mm Hg/s vs（ 6 353 ± 475） mm Hg/s; both P〈0. 01],inhibited cardiac hypertrophy [left ventricular index： 3. 340 ± 0. 121 vs 4. 244 ± 0. 102; cardiomyocyte area：（ 332. 9 ± 28. 9） μm2vs（ 401. 6 ± 33. 2） μm2; both P〈0. 01]and attenuated cardiac fibrosis（ collagen volume fraction：7. 76% ± 0. 85% vs 12. 48% ± 1. 82%; P〈0. 01） in aortic constricted rats. However,RDN didn＇t cause significant reduction of blood pressure in aortic constricted rats（ P〉0. 05）. RDN prevented the AC-induced increase in the plasma NE concentration,renin activity,Ang II concentration and cardiac Ang II level. CONCLUSION： RDN may directly prevent cardiac hypertrophy and fibrosis and improve cardiac function via regulating the sympathomimetic activity and renin-angiotensin system.

关 键 词：肾交感神经去除术 心肌肥厚 心肌纤维化 交感活性 肾素-血管紧张素系统 

分 类 号：R541[医药卫生—心血管疾病]