心脏神经节丛刺激对急性心肌梗死后心力衰竭犬心脏功能及自主神经重构的影响  

Effects of ganglionated plexi stimulation on cardiac function and autonomic remodeling in a canine model of acute heart failure post-myocardial infarction

作　　者：胡慧慧[1] 罗达 秦智亮 马瑞松 余小梅[1] 何勃[1] 鲁志兵[1] 李元红 江洪[1] HU Hui-hui;LUO Da;QIN Zhi-liang;MA Rui-song;YU Xiao-mei;HE Bo;LU Zhi-bing;LI Yuan-hong;JIANG Hong(Department of Cardiology,Renmin Hospital of Wuhan University,Wuhan 430060, Hubei,China;Department of Cardiology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, Hubei, China)

机构地区：[1]武汉大学人民医院心内科,湖北武汉4300602 [2]湖北省恩施土家族苗族自治州中心医院心内科,湖北恩施445000

出　　处：《中国心脏起搏与心电生理杂志》2018年第1期73-77,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金资助项目(编号:81300181;81370281;81400254;81530011);湖北省自然科学基金杰青项目(2015CFA051)

摘　　要：目的研究低强度心脏神经节丛(GP)刺激对急性心肌梗死(AMI)后急性心力衰竭(简称心衰)犬心脏功能及自主神经重构的影响。方法体重18~20kg正常成年杂种犬18只按4∶5比例随机分为对照组(n=8)和GP刺激组(GPS组,n=10),以戊巴比妥钠麻醉后开胸,结扎冠状动脉左前降支后1h以180~240次/分快速心室起搏(VP)GPS组AMI后行低GP刺激,对照组不予GP刺激。GPS组分别在基础状态、AMI 1h、VP-3h、VP-6h,对照组于相应时间进行心脏超声。检测左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、收缩末期室间隔厚度(IVSS)和左室射血分数(LVEF)。GPS组于基础状态、AMI-1h、VP-2h、VP-4h、VP-6h,对照组于相应时间采静脉血并采用犬酶联免疫吸附测定血清去甲肾上腺素(NE)、B型脑钠肽(BNP)、血管紧张素Ⅱ(Ang-Ⅱ)的水平,实验结束后处死犬取心肌组织。采用Western Blot法检测心肌梗死周边区生长相关蛋白43(GAP-43)、酪氨酸羟化酶(TH)以及左侧星状神经节c-fos、神经生长因子(NGF)的表达。结果与基础状态相比,两组AMI-1h、VP-3h、VP-6h的LVEDV、LVESV均有增加趋势,LVEF、IVSS均有减少趋势,但组内各时间点的LVEDV、LVESV、LVEF无差异(P均>0.05);与对照组相比,GPS组的LVEDV、LVESV和LVEF无显著差异(P均>0.05),但GPS组分别在VP-3h、VP-6h时测得的IVSS都显著高于对照组(P均<0.05)。VP 6h后,与对照组相比,GPS组有改善LVEF的趋势,但无差异(P=0.074)。与基础状态相比,两组AMI-1h血浆NE、BNP、Ang-Ⅱ水平显著升高(P均<0.05);与对照组相比,GPS组VP-6h时显著抑制AMI导致的NE、BNP、Ang-Ⅱ水平升高(P均<0.05)。GPS组心肌梗死周边区GAP43和TH的表达显著低于对照组(P<0.05),左侧星状神经节c-fos和NGF的表达亦显著低于对照组(P<0.05)。结论低强度GP刺激可改善左室功能,抑制AMI后VP所致急性心衰犬的心脏交感神经重构。Objective To investigate the effect of low-intensity ganglionated plexi stimulation （GPS） on cardiac function and autonomic remodeling in a canine model of acute heart failure （HF） post-myocardial infarction. Methods Eighteen adult mongrel male dogs were randomized into the control （n=8） and GPS （n=10） groups. All dogs underwent left anterior descending artery ligation to induce acute myocardial infarction and followed by 6-hour high-rate （ 180 - 240 bpm） ventricular pacing （VP）. Transthoracic 2-dimensional echocardiography was respectively performed at time points of baseline, 1 h after AMI （MI 1 h）, 3 h after VP （VP 3 h） and 6 h after VP （VP 6 h）. The plasma levels of norepinephrine （NE） , B-type natriuretic peptide （BNP） and Ang Ⅱ were measured using ELISA kits at baseline, MI 1 h,VP 2 h, VP 4 h and VP 6 h. C-fos and nerve growth factor （NGF） proteins expressed in the left stellate ganglion as well as GAP43 and TH proteins expressed in the pert-infarct zone were measured using western blot. Results Compared with the baseline, two groups had an increasing trend of LVEDV, LVESV and descending trend of LVEF, IVSS at AMI 1 h, VP-3 h and VP-6 h respectively, but there was no significant difference in LVEDV, LVESV, LVEF and IVSS in each group at each time point（both P〉 0.05）. No significant differences were showed in the left ventricutar end diastolic volume, end-systolic volume and e jection fraction between the control and GPS groups at each time point, but the interventricular septal thickness at end-systole in the GPS group at VP 3 h and VP 6 h was significantly higher than that in the control group. There was a trend of improvement in LVEF in the GPS group at the 6th hour of VP compared to that in the control group, ahhough the difference was not statistically significant（P=0.074）. The plasma levels of NE, BNP, Ang-Ⅱ were respectively increased 1 hour after myocardial infarction when compared to baseline （both P〈0.05）. At the time point of VP-6

关 键 词：心血管病学 神经节丛刺激 心肌梗死 心力衰竭 自主神经系统 

分 类 号：R542.22[医药卫生—心血管疾病] R541.61[医药卫生—内科学]