肾去交感神经对间断快速右房起搏犬心房电生理特性的影响及机制探讨  

Effect of renal sympathetic denervation on the atrial electrophysiology in canines with long-term intermittent atrial pacing

作　　者：王徐乐[1] 代子玄[1] 王晓占[1] 郭宗文[1] 黄鹤[1] 唐艳红[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,武汉大学心血管病研究所,湖北武汉430060

出　　处：《中国心脏起搏与心电生理杂志》2015年第2期155-158,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家科技支撑计划项目(项目编号:2011BAI11B12)

摘　　要：目的探讨肾去交感神经（RSD）对间断快速右房起搏犬心房电生理特性的影响及机制。方法19只比格犬分为假手术组（n=6）、对照组（n=6）和RSD组（n=7）三组。假手术组植入起搏器后程控关闭起搏器；对照组植入起搏器后长期间断起搏右房；RSD组行双侧肾动脉消融后同时植入起搏器；对照组和RSD组每日右房快速（400—450次／分）起搏8h，共12周。所有犬在试验基线期和终点进行收缩压、舒张压、右房压、肺动脉压和肺毛细血管楔压等血流动力学测量及心房颤动（简称房颤）诱发和心房有效不应期（AERP）、P波时限等电生理检查；取静脉血检测血管紧张素Ⅱ（AngⅡ）和醛固酮水平。结果基线期三组间所有检测指标无差异（P〉0．05）。试验终点，RSD组收缩压和舒张压较对照组明显降低（P〈0．05）；与对照组相比，RSD组右房压、肺动脉压和肺毛细血管楔压的升高（P〈0．05）。与假手术组和RSD组相比，对照组房颤持续时间及次数均明显升高（P〈0．05）。与对照组相比，RSD组的AERP[（117．4±2．2）msVS（108．3±5．6）ms，P〈0．05]和房颤周长[（122．5±6．6）msvs（102．3±8．7）ms，P〈0．05]明显延长，而AERP离散度、P波时限及其离散度显著减小（P〈0．05）。与假手术组相比，对照组AngⅡ和醛固酮水平显著升高；而与对照组相比，RSD组其升高的趋势明显减缓[AngⅡ，（1174．9±181．9）pg／mlVS（2877．9±376．9）pg／ml，P〈0．01；醛固酮，（161．4±38．3）pg／mlvs（377．9±63．7）pg／ml，P〈0．01]。结论肾去交感神经可抑制心房电重构，其机制不仅与肾去交感神经后肾素．血管紧张素-醛固酮系统活性降低有关，还与其抑制间断快速右房起搏导致的血流动力学改变有关。Objective To explore the effect of renal sympathetic denervation （RSD） on the atrial electrophysiology in canines with long-term intermittent atrial pacing. Method Nineteen beagles were randomly divided into sham-operated group （6 dogs ）, control group （6 dogs）, and RSD group （7 dogs）. Sham-operated group were implanted with pacemakers without pacing. Control group were implanted with pacemakers with long-term intermittent atrial pacing,＇and RSD group un- derwent catheter-based RSD bilaterally and were simultaneously implanted with pacemakers. Right atrial pacing was main- tained for 8 hours a day and a total of 12 weeks in control group and RSD group. Electrophysiological and hemodynamic pa- rameters were measured in all the animals at the baseline and endpoint of the protocol. The plasma levels of angiotensin Ⅱ and aldosterone were examined by ELISA. Results There was no significant difference in all the measurements among three groups at the baseline of the study （P〉0.05）. Compared with the control group, RSD prevented the increase of right atrial pressure, mean pulmonary artery pressure and pulmo- nary capillary wedge pressure induced by long-term inter- mittent atrial pacing （ P 〈 0.05 ）. Similarly, RSD de- creased systolic and diastolic blood pressure after long- term intermittent atrial pacing （ P 〈 0. 05 ）. Compared with control group , RSD group had fewer incidences of atrial fibrillation （AF） and a shorter duration of AF （P〈0.05） after long-term intermittent atrial pacing. In addition to increased AERP [ （117.4±2.2） ms vs （ 108.3 ±5.6） ms, P〈0.05 ] and AF cycle length [ （ 122.5 ±6.6） ms vs （ 102.3 ±8.7） ms,P〈 0.05 ], AERP dispersion and P-wave duration and dispersion were significantly decreased in the RSD group compared with the control group （P〈0.05）. The plasma levels of angiotensin Ⅱ and aldosterone increased significantly in control group, but the increasing trend was inhibited by RSD [ Angiotensin Ⅱ, （1174.9±181.9

关 键 词：心血管病学 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]