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心肌缺氧时慢速心律失常腺苷假说的验证及意义

EXPERIMENTALSTUDYONADENOSINEHYPOTHESISOFBRADYARRHYTHMIASOCCURRINGINMYOCARDIALHYPOXIAANDITSCLINCALSIGNIFICANCE

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【作者】 孙继文徐江袁芳孟繁英

【Author】 SunJiwenXuJiang,YuanFang,etal.DepartmentofPathophysiology,CapitalUniversityofMedicine,Beijing10054

【机构】 首都医科大学病理生理教研室

【摘要】 为研究心肌缺氧时慢速心律失常腺苷假说的意义,在豚鼠和兔的整体及离体心肌缺氧模型上,用酶鉴别分光光度法、相关因素同步定量分析及腺苷拮抗剂作了内生性腺苷的实验研究。结果表明,缺氧心肌的内生性腺苷显著增多(从对照组的每克心肌组织5.8±1.7nmol增至吸入5%氧组的27.5nmol±2.0nmol,P<0.01)。注射外源性腺苷所致的窦性心动过缓及房室阻滞,与心肌缺氧引起者在表现形式及量效关系上都极为相似。二者的希氏束心电图皆呈A-H间期延长而H-V间期不变,说明传导阻滞的部位相同。从三因素同步定量分析得出内生性腺苷与心律失常间比较,r=0.99,P<0.01;用氨茶碱(腹腔内注射50mg)能完全阻断豚鼠吸入5%氧组及2%氧组Ⅱ~Ⅲ度房室传导阻滞的发生,提示腺苷与慢速心律失常有因果关系。在临床上应给予腺苷拮抗剂,如甲基黄嘌呤类(氨茶碱)治疗。

【Abstract】 Importantroleofendogenousadenosineinthepathogenesisofhypoxicbradyarrhythmiaswasverifiedexperimentalybothinvivoandinvitromodelsofmyocardialhypoxiain180guineapigsand40rabbitsbyusingenzymediferentialspectrophotometry,synchronousquantitativeanalysisofcorelat-edfactorsandadenosineantagonist.Resultsdisclosedthatendogenousadenosineinhypoxicmyocardiumincreasedmarkedlyfromagrammyocardialtissue5.8±1.7nmolofthecontrolgroupto27.5±2.0nmolof5%O2inhalationgroup(P<0.01).SinusbradycardiaandA-VblockinducedbyinjectionofexogenousadenosinewerecloselyakintothosecausedbymyocardialhypoxiabothinECGcharacteristicsanddose-re-sponsecurve.BothoftheirHiselectrogramsshowedprolongationofA-HintervalbutnochangeofH-Vinterval,indicatingthesamelocalityofconductionblock.Synchronousquantitativeanalysisof3relat-edfactorsrevealedacorrelationcoeficientof0.99(P<0.01)betwenendogenousadenosineandbrad-yarhythmias,denotingasubordinateinsteadofcoordinaterelation.Moreover,causeandefectrelationcouldbeshownbetweenthemfromtheresultthataminophyline(50mg,ip)couldabolishcompletelyⅡ°-Ⅲ°A-Vblockwhichwouldotherwisebeboundtooccurafterinhalationof5%O2.Thepresentstudyisthefirstinvivoexperimentalverificationofadenosinehypothesisthroughouttheworldwhichnotonlycanwelexplainthoseatropine-resistantcases,butalsoopensupthewaytoanentirelynewtherapeuticstrate-gyforthesekindsofbradyarrhythmias,i.e.insteadofM-cholinoceptorblocker,adenosineantag-onist(methylxanthines,e.g.aminophyline)shouldbeprescribed.

【关键词】 心肌梗塞心律失常腺苷
【Key words】 MyocardialinfarctionArhythmiaAdenosine
  • 【文献出处】 中华内科杂志 ,CHINESE JOURNAL OF INTERNAL MEDICINE , 编辑部邮箱 ,1996年04期
  • 【分类号】R541.7
  • 【被引频次】12
  • 【下载频次】51
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