风湿性心脏病伴心房颤动患者心房交感神经密度的观察

Observation of sympathetic nerve density in the atrium in patients with rheumatic heart disease accompanying atrial fibrillation

目的探讨心房自主神经密度与风湿性心脏病(RHD)患者心房颤动(简称房颤)发生风险的关系。方法研究共纳入50例患者,其中伴房颤的RHD患者(A组)和不伴房颤的RHD患者(B组)各25例。收集所有患者的基础资料并测定血清肾素、超敏C反应蛋白以及血管紧张素Ⅱ水平。经开胸手术获取右心耳组织标本并以免疫组织化学方法进行自主神经染色。结果 A组患者左房内径、血浆肾素水平及血管紧张素Ⅱ水平均显著高于B组(P<0.05),但两组患者的血沉及C反应蛋白无明显差异。与B组患者相比,A组患者右心耳内膜和外膜交感神经密度均显著增高(P<0.05),但两组患者副交感神经密度无明显差异。结论伴房颤的RHD患者存在心房高交感神经支配,此可能与房颤发生有关。

Objective To investigate the association between the autonomic density and the risk of atrial fibrillation （AF） in rheumatic heart disease （RHD） patients. Methods Fifty patients were enrolled： （A） RHD patients with AF （n =25, group 1 ） and （B） RHD patients without AF （n =25, group 2）. The baseline characteristics and the blood con- centrations of renin, C-reaction protein and angiotensin II were collected from all patients. The tissues were obtained from the fight atrial appendage during the open-heart surgery and then stained using immunohistochemical methods with autonom- ic antibodies. Results The left atrial diameter was larger in group 1 than that in group 2. The blood concentrations of renin and angiotensin II were higher in than those in group 2. The erythrocyte sedimentation rate and blood concentrations of C-reaction protein did not show significant change between the two groups. The sympathetic nerve density was significant- ly higher in group 1 than that in group 2, both endocardially and epicardially. The parasympathetic nerve density did not show significant difference between the two groups. Conclusion This study provids direct evidence of the increase in sympathetic nerve density in atrium in patients with RHD. This phenomenon may be associated with the development of AF in RHD patients.