迷走神经刺激在慢性心力衰竭中的应用

Application of vagus nerve simulation in patients with chronic heart failure

在心衰的发生和发展过程中,不仅存在交感神经的激活,而且存在副交感神经功能减退。动物研究显示迷走神经刺激有助于逆转心衰的心室重构,提高迷走神经张力有助于增加心衰患者心肌内NO合成、减少炎症因子和增加缝隙蛋白的表达。Cardio Fit和ANTHEM-HF等临床研究证实迷走神经刺激(vague nerve stimulation,VNS)的安全性及有效性。但新近发布的NECRAR-HF研究未能证实VNS在改善心脏重构和提高心功能的作用。更大样本量的随机对照研究有助于进一步证实VNS的疗效。

Chronic heart failure（HF） is associated with autonomic dysregulation characterized by as sustained increase in sympathetic drive and by withdrawal of parasympathetic activity. Experimental data have demonstrated that stimulation of the vague nerve is able to reverse ventricular remodeling of the failing heart. There is also evidence that increasing parasympathetic activity may stimulate the production of nitric oxide, reduce the devastating inflammatory process and increase the myocardial expression of gap junction proteins in HF. Several clinical trial s including Cardio Fit and ANTHEM-HF have proven the safety and effectivity of vague nerve stimulation（VNS） in HF patient. But recently published data from NECTAR-HF trial failed to demonstrate a significant effect on cardiac remodeling and function capacity in HF patient. A prospective randomized trial with a larger patient cohort is needed to confirm the beneficial results of VNS.