昼夜心房快速起搏对犬心房颤动诱发及自主神经重构的影响  

Effect of day-night pattern of rapid atrial pacing on the inducibility of atrial fibrillation and autonomic neural remodeling in canines

作　　者：张淑娟[1] 黄从新[1] 赵庆彦[1] 代子玄[1] 赵红宜 钱永生[1] 张友京 王友成 何勃[1] 唐艳红[1] 王腾[1] 王晞[1] Zhang Shujuan;Huang Congxin;Zhao Qingyan;Dai Zixuan;Zhao Hongyi;Qian Yongsheng;Zhang Youjing;Wang Youcheng;He Bo;Tang Yanhong;Wang Teng;Wang Xi(Department of Cardiology,Renmin Hospital of Wuhan University,Cardiovascular Research Insititute of Wuhan University,Hubei Key Laboratory of Cardiology,Wuhan 430060,China)

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心血管病湖北省重点实验室,430060

出　　处：《中华心律失常学杂志》2020年第2期160-165,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81670303)。

摘　　要：目的探讨昼夜不同时间对犬行右心房快速起搏(RAP)观察其对心房颤动(房颤)诱发情况及自主神经重构的影响。方法18只杂种犬按随机数字表法均分为白天起搏组(D组)、夜间起搏组(N组)和对照组(C组),各6只。其中,D组起搏时间为6:00至18:00,N组为18:00至次晨6:00,C组为装入起搏器不起博。所有犬饲养8周后测定其心率变异性(HRV)、各部位不应期(ERP)及房颤诱发情况,同时测定血清及心房组织中肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和乙酰胆碱(ACh)水平,心房组织中交感神经(TH)和副交感神经(ChAT)的表达情况,以观察昼夜心房刺激对炎性因子及神经重构的影响。结果8周后,D组和N组HRV各参数除低频(LF/HF)外均显著高于C组,且D组亦明显高于N组,而C组中HRV各参数与基线期比较差异无统计学意义(均P<0.05)。D组各部位ERP均显著低于N组,ERP离散度(dERP)则高于N组[(27.33±5.16)ms对(17.67±6.86)ms,P<0.05];与C组比较,N组各部位ERP均较低且dERP较高[(17.67±6.86)ms对(9.50±3.27)ms,P<0.05]。D组的房颤诱发率显著高于N组和C组[(70.37%±18.14%)对(46.30%±19.14%),(11.11%±0.99%),均P<0.05]。与N组和C组比较,D组犬RAP可明显升高ChAT、TNF-α和IL-6,降低TH和ACh水平。结论长期间断白天心房RAP较夜间RAP更易诱发犬心房电重构和神经重构,进而促进房颤发展。Objective To investigate the effects of rapid atrial pacing(RAP)at different time in day-time and night-time on the inducibility of atrial fibrillation(AF)and autonomic neural remodeling in canines.Methods Eighteen mongrel dogs were implanted with atrial pacemakers and randomly divided into three groups.The C Group was implanted with pacemakers without pacing.The D and N groups were performed with RAP at 400 beats/min for 8 weeks,the D Group was given RAP from 6:00 am to 18:00 pm,and the N Group was from 18:00 pm to 6:00 am.Heart rate variability(HRV)and electrophysiological indexes,the concentrations of tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6)and acetylcholine(ACh),tyrosine hydroxylase(TH)and choline acetyltransferase(ChAT)were measured in all animals.Results At the end-point of the study,the parameters of HRV were higher in the D Group than in the N Group.When compared with the N Group,the effective refractory period(ERP)of recording sites were all lower in the D Group while the dERP was higher[(27.33±5.16)ms vs.(17.67±6.86)ms,P<0.05],and the ERP at atrium were lower in the N Group than in the C Group while the dERP was higher in the N Group than in the C Group[(17.67±6.86)ms vs.(9.50±3.27)ms,P<0.05].The D Group had higher vulnerability of AF than that in the N and C Groups[(70.37%±18.14%)vs.(46.30%±19.14%),(11.11%±0.99%),all P<0.05].RAP in the D Group markedly increased the concentrations of ChAT,TNF-αand IL-6,but inhibited the increase in TH and ACh.Conclusion Long-term intermittent daytime atrial RAP is more likely to induces atrial eletrophysiological and autonomic neural remodeling,thus promoting the development of AF.

关 键 词：心房颤动 自主神经系统 心率变异性 电重构 昼夜节律性 

分 类 号：R54[医药卫生—心血管疾病]