移植心脏电生理改变与移植物排斥反应关系的研究

Study on the relationship between electrophysiological change in heterotopic heart transplants and acute heart graft rejection in rats

目的 探讨非创伤性监测及诊断心脏移植后急性移植物排斥反应 (GR)方法。方法通过大鼠颈部心脏移植模型观察急性GR过程中移植心脏电生理改变 ,即房室传导有效不应期(ERP AVCS)改变与移植心脏形态学改变的关系。结果 同系移植及异系移植免疫抑制剂投用组ERP AVCS无延长 ;异系移植组移植后第 3天 ,其ERP AVCS出现明显延长 [(96.88± 6.77)ms ,P <0 .0 5 ] ,第 5天为 (114 .62± 7.46)ms(P <0 .0 1) ,第 7天为 (12 1.67± 9.73 )ms(P <0 .0 1)。同系移植及异系移植 +免疫抑制剂投用组形态学结构未见异常 ;异系移植组在移植后第 3天开始出现急性GR ,如心肌纤维间质明显增宽、排列紊乱 ,血管旁及间质内出现单核细胞等且第 5天及第 7天急性GR渐加重。异系移植心脏ERP AVC与排斥反应形态学改变呈明显正相关 (P <0 .0 1)。结论 检测移植心脏ERP AVC是简便、可靠、低费用。

Objective To evaluate the correlation between effective refractory period of atrioventricular conduction system (ERP AVCS) and histopathological changes, to assess if ERP AVCS could be a noninvasive procedure for frequently monitoring of acute heart graft rejection (GR). Methods Three kinds of heterotopic neck heart transplants were performed. Group A: WKA rats received WKA rat isografts ( n =32), group B: WKA rats received Fisher 344 allografts ( n =30), and group C: WKA rats received Fisher 344 allografts treated with immunosuppressants ( n =32, 15 deoxyspergualin 5 mg/kg and prednisolone 5 mg/kg per day after transplantation). The correlation between ERP AVCS changes and the morphological changes in the grafts was observed during acute heart GR. Results The ERP AVCS in the groups A and C was not prolonged, while in the group B it was significantly prolonged from the day 3 to 7 after transplantation (96.88±6.77 ms at the day 3, P <0.05; 114.62±7.46 ms at the day 5, P <0.01; 121.67±9.73 ms at the day 7, P <0.01). Histopathologically, no abnormalities occurred in the groups A and C, but in the group B, progressive moderate to severe GR occurred from the day 3 to 7 after transplantation. The correlation between the ERP AVCS and histopathologic grade was particularly notable in the group B ( r =0.926, Y =9.00 X +90.43, P <0.01). Conclusion Determination of ERP AVCS is a promising simple noninvasive procedure for detecting acute heart GR.