自体窦房结细胞异位移植治疗缓慢型心律失常的实验研究.docVIP

基础研究 自体窦房结细胞异位移植治疗缓慢型心律失常的实验研究 张浩 宋智钢 段炼 姚颖龙 邹毅清 宗刚军 徐志云 [摘要] 目的 探索自体窦房结细胞异位移植，构建心室异位起搏灶治疗缓慢型心律失常的可行性。 方法 将健康成年犬16只随机分为移植组和对照组（每组8只）。移植组切取窦房结组织并制成细胞悬液后，注射到自体右心室近心尖部心肌内，对照组切取窦房结后,于右心室相同部位注射等量培养液。2周后建立完全性房室传导阻滞动物模型并进行电生理检查。对移植组犬经股静脉注射异丙肾上腺素和阿托品，研究心率变化。免疫荧光染色观察移植的细胞存活状况及其与心室肌细胞形成的缝隙连接结构。 结果 消化分离成年犬窦房结得到的自主搏动的细胞结构和活性保持良好。建立完全性房室传导阻滞模型1 h后，移植组犬心率(91±14)次/min高于对照组(49±11)次/min(t=6.672，P0.01)，且此室性心律起源于细胞移植部位。注射异丙肾上腺素后，移植组室性心率由(95±11)次/min增加至(118±15)次/min(t=3.497，P0.01)，而注射阿托品后室性心律无明显改变[分别为(95±11)次/min和(101±17)次/min](t=0.838，P0.05）。免疫荧光染色法证实，移植的细胞在移植部位存活，且细胞间有缝隙连接蛋白形成。 结论 成年犬窦房结细胞移植到自体右心室壁，能够提高完全性房室传导阻滞后的心室率，且对异丙肾上腺素反应良好，对阿托品无明显反应。移植的细胞可与周围细胞形成缝隙连接。 [关键词] 窦房结；细胞移植；移植，自体；心动过缓 Experimental research of autologous sinoatrial node cells heterotopic transplantation for treating bradycardia ZHANG Hao*, SONG Zhi-Gang, DUAN Lian, YAO Ying-long, ZOU Yi-Qing, ZONG Gang-Jun, XU Zhi-Yun. *Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China Corresponding author：XU Zhi-Yun [Abstract] Objective To explore the feasibility of autografting sinoatrial nodal cells to construct an ectopia pacemaker for treating bradycardia. Methods Sixteen healthy adult dogs were involved in our study. The dogs were randomly assigned to graft group or control group (n1=n2=8). The sinoatrial node (SAN) from dogs in graft group was harvested and digested into cell suspension in vitro, then injected to autogenic right ventricular wall adjacent to heart apex. Commensurable culture medium was injected to the same position with the dogs in control group. Objective Two week later, all dogs underwent transcatheter ablation of His bundle to create a complete heart block model and an electrophysiology study was carried out. For investigating the change of the rhythm, isoproterenol and atropine was injected to dogs of graft group respectiv