犬左心房与肺静脉自主神经的分布特征及其临床意义
A quantitative profile of autonomic innervation of canine left atria and pulmonary veins: implications for atrial fibrillation
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。
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.
Atrial fibrillation / Cardiac autonomic nerves / Left atria / Pulmonary vein
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