犬左心房与肺静脉自主神经的分布特征及其临床意义

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (2): 197-201.

犬左心房与肺静脉自主神经的分布特征及其临床意义

高崇瀚¹，　汪　飞²，　姜蓉³，　张　进¹，　殷跃辉¹

1. 重庆医科大学附属第二医院心内科，重庆 400010； 2. 重庆医科大学附属第一医院急诊科, 重庆 400016；
3. 重庆医科大学干细胞与组织工程研究所，重庆 400016

收稿日期:2010-10-13 出版日期:2011-03-25 发布日期:2011-03-28
通讯作者: 殷跃辉，教授，主任医师，博士生导师，E-mail: yinyuehui 63@yahoo.com.cn E-mail:gchvictor@163.com
作者简介:高崇瀚（1980-），男，博士研究生，研究方向：心脏电生理及心律失常，Tel: (023) 63693079

A quantitative profile of autonomic innervation of canine left atria and pulmonary veins: implications for atrial fibrillation

GAO Chong-han¹, WANG Fei², JIANG Rong³，ZHANG Jin¹, YIN Yue-hui¹

1.Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China;2.Department of Emergency, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; 3. Laboratory of Stem Cell and Tissue Engineering, Chongqing Medical University, Chongqing 400016, China

Received:2010-10-13 Online:2011-03-25 Published:2011-03-28

摘要/Abstract

摘要：

目的　定量研究犬左心房（LA）及肺静脉（PV）不同区域心脏自主神经的分布，并探讨其在心房颤动中的意义。方法 8只健康成年杂种犬于急性生理实验后立即处死，分别收集左心房后壁（PLA）、左心房顶（LAR）、左心房前壁（ALA）、房间隔（IAS）、左心耳（LAA）及肺静脉（PV），免疫组化染色分别标记交感、副交感神经，定量测定不同区域交感、副交感神经密度。结果交感、副交感神经在左心房和肺静脉不同区域间的分布相似。不同区域交感神经密度，除PV vs. PLA（P= 0.211）, IAS vs. LAR （P =0.140）及 LAR vs. ALA（P=0.204）外，其余区域两两比较均有统计学意义（P<0.05 或 P<0.01）；不同区域副交感神经密度，除PV vs. PLA （P= 0.256）, IAS vs. LAR （P= 0.130）, LAR vs. ALA （P= 0.238）及 ALA vs. 　LAA （P= 0.124）外，其余区域两两比较均有统计学意义（P<0.05 或 P<0.01）,不同区域交感、副交感神经密度由高至低依次均为：PLA>PV>IAS>LAR>ALA>LAA。交感、副交感神经密度从心房及肺静脉组织外层、心肌层至内层呈梯度下降，两两比较均有统计学意义（P<0.001）。肺静脉近端交感、副交感神经密度明显高于远端（P<0.001）。结论心脏自主神经在LA及PV呈区域异质性分布，这与房颤的发生及维持密切相关，在房颤的消融治疗中可能具有重要意义。

关键词: 心房颤动, 心脏自主神经, 左心房, 肺静脉

Abstract:

Objective　To quantitatively determine the cardiac autonomic innervation in different regions of the left atria and pulmonary veins in dogs and investigate its implications in atial fibrillation.　Methods　8 healthy adult mongrel dogs were euthanized immediately after acute physiological experiments. The heart and great vessels were rapidly removed en bloc through a median sternotomy. Tissue samples were obtained from the posterior left atrium (PLA), left atrial roof (LAR), anterior left atrium (ALA), interatrial septum (IAS), left atrial appendage (LAA) and pulmonary veins (PVs). Nerve density of tissue samples were determined by immunohistochemical staining and comupter-assisted morphometric analysis system.　Results　Sympathetic and parasympathetic nerves distributed through the LA and PVs in a similar way. Both sympathetic and parasympathetic nerve densities decreased in the order: PLA>PV>IAS>LAR>ALA>LAA. For sympathetic nerves, multiple comparisons between any two regions showed a significant difference(P<0.05 or P<0.01) except for PV versus PLA (P=0.211), IAS versus LAR (P=0.140), and LAR versus ALA(P= 0.204); for parasympathetic nerves, all the differences between any pair of regions were statistically significant (P<0.05 or P<0.01) with the exception of PV versus PLA(P= 0.256), IAS versus LAR(P=0.130), LAR versus ALA (P= 0.238), and ALA versus LAA (P=0.124). For both nerve types, there was a decreasing gradient of nerve densities from the external to internal layer(P<0.001,each comparisons). Nerve density for either nerve type was significantly higher at the ostia than the distal segments of PVs(P<0.001).　Conclusions　The left atria and PVs are innervated by sympathetic and parasympathetic nerves in a regionally heterogeneous way, which may has close relation with the initiation and perpetuation of AF and be of important significance for AF ablation.

Key words: Atrial fibrillation, Cardiac autonomic nerves, Left atria, Pulmonary vein

中图分类号:

R541.75

高崇瀚, 汪飞, 姜蓉, 张　进, 殷跃辉. 犬左心房与肺静脉自主神经的分布特征及其临床意义[J]. 中国临床解剖学杂志, 2011, 29(2): 197-201.

GAO Chong-Han, WANG Fei, JIANG Rong, ZHANG 　Jin, YIN Ti-Hui. A quantitative profile of autonomic innervation of canine left atria and pulmonary veins: implications for atrial fibrillation[J]. Chinese Journal Of Clinical Anatomy, 2011, 29(2): 197-201.

参考文献

[1] Nattel S. New ideas about atrial fibrillation 50 years on
[J]. Nature, 2002, 415(6868):219-226.

[2] Kneller J, Zou R, Vigmond EJ, et al. Cholinergic atrial fibrillation in a computer model of a two-dimensional sheet of canine atrial cells with realistic ionic properties
[J]. Circ Res, 2002, 90(9):E73-87.

[3] Chou CC, Nihei M, Zhou S, et al. Intracellular calcium dynamics and anisotropic reentry in isolated canine pulmonary veins and left atrium
[J]. Circulation, 2005, 111(22):2889-2897.

[4] Chou CC, Nguyen BL, Tan AY, et al. Intracellular calcium dynamics and acetylcholine-induced triggered activity in the pulmonary veins of dogs with pacing-induced heart failure
[J]. Heart Rhythm, 2008, 5(8):1170-1177.

[5] Coumel P. Clinical approach to paroxysmal atrial fibrillation
[J]. Clin Cardiol, 1990, 13(3):209-212.

[6] Bettoni M, Zimmermann M. Autonomic tone variations before the onset of paroxysmal atrial fibrillation
[J]. Circulation, 2002, 105(23):2753-2759.

[7] Pappone C, Santinelli V, Manguso F, et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation
[J]. Circulation, 2004, 109(3):327-334.

[8] Ogawa M, Zhou S, Tan AY, et al. Left stellate ganglion and vagal nerve activity and cardiac arrhythmias in ambulatory dogs with pacing-induced congestive heart failure
[J]. J Am Coll Cardiol, 2007, 50(4):335-343.

[9] Tan AY, Zhou S, Ogawa M, et al. Neural mechanisms of paroxysmal atrial fibrillation and paroxysmal atrial tachycardia in ambulatory canines
[J]. Circulation, 2008, 118(9):916-925.

[10]Liu L, Nattel S. Differing sympathetic and vagal effects on atrial fibrillation in dogs: role of refractoriness heterogeneity
[J]. Am J Physiol, 1997, 273(2 Pt 2):H805-816.

[11]Hirose M, Carlson MD, Laurita KR. Cellular mechanisms of vagally mediated atrial tachyarrhythmia in isolated arterially perfused canine right atria
[J]. J Cardiovasc Electrophysiol, 2002, 13(9):918-926.

[12]Patterson E, Po SS, Scherlag BJ, et al. Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation
[J]. Heart Rhythm, 2005, 2(6):624-631.

[13]Lemery R, Birnie D, Tang AS, et al. Feasibility study of endocardial mapping of ganglionated plexuses during catheter ablation of atrial fibrillation
[J]. Heart Rhythm, 2006, 3(4):387-396.

[14]Cummings JE, Gill I, Akhrass R, et al. Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans
[J]. J Am Coll Cardiol, 2004, 43(6):994-1000.

[15]Ndrepepa G, Karch MR, Schneider MA, et al. Characterization of paroxysmal and persistent atrial fibrillation in the human left atrium during initiation and sustained episodes
[J]. J Cardiovasc Electrophysiol, 2002, 13(6):525-532.

[16]Sanders P, Hocini M, Jais P, et al. Complete isolation of the pulmonary veins and posterior left atrium in chronic atrial fibrillation. Long-term clinical outcome
[J]. Eur Heart J, 2007, 28(15):1862-1871.

[17]Morillo CA, Klein GJ, Jones DL, et al. Chronic rapid atrial pacing. Structural, functional, and electrophysiological characteristics of a new model of sustained atrial fibrillation
[J]. Circulation, 1995, 91(5):1588-1595.