局部肉毒素微注射调控左侧星状神经节活性防治心肌梗死后室性心律失常  

Local botulinum toxin microinjection protects against ventricular arrhythmias after myocardial infarction by modulating left stellate ganglion neural activity

作　　者：陈华强 王钧 孟冠南 刘承哲 王猛 周振 周丽平[1] 郭辅定 于智瑶 段首鹏 邓强 孙吉 江洪[1] 余锂镭[1] Chen Huaqiang;Wang Jun;Meng Guannan;Liu Chengzhe;Wang Meng;Zhou Zhen;Zhou Liping;Guo Fuding;Yu Zhiyao;Duan Shoupeng;Deng Qiang;Sun Ji;Jiang Hong;Yu Lilei(Department of Cardiology,Renmin Hospital of Wuhan University,Cardiac Autonomic Nervous System Research Center of Wuhan University,Cardiovascular Research Institute,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,武汉大学心脏自主神经研究中心,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》2021年第4期311-316,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81871486,81970287,81770364)。

摘　　要：目的探究局部微注射A型肉毒素(BTA)调控左侧星状神经节(LSG)神经活性与功能,对心肌梗死(MI)后室性心律失常发生的防治作用。方法 15只成年雄性比格犬依据随机数字表法被分为肉毒素组(n=8)和对照组(n=7),分别应用微量泵向LSG注射肉毒素溶液或生理盐水。记录基础状态和微注射后LSG神经功能和神经活性,测定心室有效不应期(ERP)。结扎左冠状动脉前降支制备MI模型,连续记录1 h心电图用以分析室性心律失常发生情况。结果与对照组相比,BTA微注射显著抑制心脏交感神经活性[微注射后4 h:频率(38.86±3.89)次/min对(21.43±5.97)次/min,振幅(0.11±0.01)mV对(0.04±0.01)mV,P均<0.05)]和功能[微注射后4 h,15.0 V:(60.96±9.30)%对(22.34±4.84)%,P<0.05],延长左心室ERP[左心室心尖部:(163.67±7.09)ms对(185.67±4.63)ms;左心室心中部:(165.33±5.32)ms对(182.00±5.93)ms;左心室心底部:(163.67±5.85)ms对(179.00±6.03)ms,P均<0.05],减少室性心律失常发生[室性早博:(67.71±14.09)次/h对(8.13±3.91)次/h;非持续性室性心动过速(VT):(12.00±4.28)阵/h对(1.13±1.13)阵/h;持续性VT/心室颤动发生率:71.4%对12.5%;P均<0.05]。结论局部微注射BTA可抑制LSG神经活性,防治MI后室性心律失常的发生。Objective To investigate whether the microinjection of botulinum toxin A(BTA)could block left stellate ganglion(LSG)activity and prevent myocardial infarction(MI)-induced ventricular arrhythmias(VA).Methods Fifteen beagles were randomized into the BTA group(n=8)and the control group(n=7)using a random number table.BTA or physiological saline was microinjected into the LSG.LSG function,neural activity and the ventricular effective refractory period(ERP)were measured before and after microinjection.MI was then induced by left anterior descending artery occlusion,and the electrocardiogram was continuously recorded for 1h to analyze the occurrence of VA.Results Compared with the control group,BTA significantly inhibited neural activity[4 h,frequency:(38.86±3.89)/min vs.(21.43±5.97)/min;amplitude:(0.11±0.01)mV vs.(0.04±0.01)mV,all P<0.05]and LSG function[4 h,15.0 V:(60.96±9.30)%vs.(22.34±4.84)%,P<0.05],and prolonged ventricular ERP[left ventricular apex:(163.67±7.09)ms vs.(185.67±4.63)ms;the median of the left ventricule:(165.33±5.32)ms vs.(182.00±5.93)ms;left ventricular base:(163.67±5.85)ms vs.(179.00±6.03)ms,all P<0.05],and decreased the occurrence of VA[ventricular premature beats:(67.71±14.09)/h vs.(8.13±3.91)/h;non-sustained ventricular tachycardia:(12.00±4.28)/h vs.(1.13±1.13)/h;ventricular tachycardia/ventricular fibrillation:71.4%vs.12.5%,all P<0.05].Conclusion Microinjection of BTA could block LSG neural activity and prevent MI-induced VA.

关 键 词：星状神经节 肉毒素 室性心律失常 心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病] R541.7[医药卫生—内科学]