CAJ | 학술논문

目的探讨星状神经节(SG)刺激诱发急性心房颤动(房颤)及心房电重构与神经重构的机制.方法将健康家犬12只(18～25kg)随机分为2组:对照组(n=6),单纯快速心房起搏(RAP)；SG组(n=6),左侧或右侧SG刺激+RAP.测定房颤诱发率、房颤持续时间,观察心房电重构和神经重分布.结果 ①与基础值相比,SG刺激显著增高房颤诱发率(P＜0.05),并延长房颤持续时间(P＜0.05)；②SG组有效不应期(ERP)显著缩短(P＜0.05),ERP离散度显著增加(P＜0.05),ERP频率适应性不良(P＜0.05)；③SG组心肌组织酪氨酸羟化酶(TH)、胆碱乙酰转移酶(ChAT)和生长相关蛋白-43(GAP-43)阳性神经纤维密度均高于对照组(P＜0.05).结论 SG刺激使心房和肺静脉部位的房颤诱发率升高,房颤持续时间延长,单侧去SG支配可减少房颤的发生和维持.交感神经活动增强可以引起心房和肺静脉发生电重构以及心房自主神经重构,急性心房电重构和急性自主神经重分布之间的恶性循环,是房颤早期诱发和维持的重要机制.
목적 탐토성상신경절(SG)자격유발급성심방전동(방전)급심방전중구여신경중구적궤제.방법 장건강가견12지(18～25kg)수궤분위2조:대조조(n=6),단순쾌속심방기박(RAP)；SG조(n=6),좌측혹우측SG자격+RAP.측정방전유발솔、방전지속시간,관찰심방전중구화신경중분포.결과 ①여기출치상비,SG자격현저증고방전유발솔(P＜0.05),병연장방전지속시간(P＜0.05)；②SG조유효불응기(ERP)현저축단(P＜0.05),ERP리산도현저증가(P＜0.05),ERP빈솔괄응성불량(P＜0.05)；③SG조심기조직락안산간화매(TH)、담감을선전이매(ChAT)화생장상관단백-43(GAP-43)양성신경섬유밀도균고우대조조(P＜0.05).결론 SG자격사심방화폐정맥부위적방전유발솔승고,방전지속시간연장,단측거SG지배가감소방전적발생화유지.교감신경활동증강가이인기심방화폐정맥발생전중구이급심방자주신경중구,급성심방전중구화급성자주신경중분포지간적악성순배,시방전조기유발화유지적중요궤제.
Objective To explore the mechanism of electrical remodeling and autonomic neural remodeling in acute atrial fibrillation (AF) induced by stellate ganglion.Methods Twelve adult mongrel dogs weighing 18 to 25 kg were randomly divided into 2 groups.Control group (n =6) underwent 6-hour rapid atrial pacing only.SG group(n =6) underwent 6-hour stellate ganglion(SG) stimulation plus rapid atrial pacing.AF induction rate,AF duration,ERP,dERP and ERP rate-adaption in left atrium (LA),right atrium (RA),left superior pulmonary vein(LSPV) and left inferior pulmonary vein (LIPV) sites were measured.The density of TH,ChAT,GAP-43 positive nerve in RA and LA were detected by immunohistochemistry staining.Results ①The induction rate of AF was significantly increased in SG group(P＜0.05),compared with baseline.The duration of AF was significantly prolonged in SG group(P＜0.05),compared with baseline.②In SG group,ERP was significantly shortened (P＜0.05),dERP was significantly increased (P＜0.05),ERP rate-adaption was significantly decreased,compared with baseline.③SG stimulation produced greater increase of the density of TH,ChAT,GAP-43 positive nerve than without SG stimulation(P＜0.05).Conclusions Stellate ganglion stimulation promoted AF induction and prolonged AF maintenance in atrial and pulmonary sites.The inhibition sympathetic nerve activation by unilateral stellate ganglionectomy can reduce the AF initiating and sustaining.Acute atrial electrical remodeling and acute autonomic neural remodeling may form a vicious cycle in which each perpetuates the other,thereby initiating and sustaining AF.This vicious cycle may help to explain how AF maintains itself in its very early stage.