本文選題：B型腦鈉肽 + 急性心肌梗死��； 參考：《福建醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的觀察急性心肌梗死并房性快速型心律失常(atrialtachyarrhythmias,ATS)對兔血漿及心肌組織B型腦鈉肽(BNP)的影響，分析BNP的變化，探討二者之間的關(guān)系和機制。 方法隨機將32只實驗兔平均分為4組，大面積心梗組、小面積心梗組、單純心律失常組、對照組。(1)大面積心梗組：結(jié)扎左冠狀動脈主干，造成心肌梗死。若無心律失常，使用電生理刺激儀，，采用S1S1方法，頻率高于刺激前頻率20次/分，于心房、心室表面各刺激10秒，誘發(fā)心律失常，適時記錄心電圖。(2)小面積心梗組：冠脈結(jié)扎位置改為左冠脈回旋支中上1/3處，結(jié)扎方法及余處理同前組。(3)單純心律失常組：僅予電刺激心臟表面5分鐘，心房頻率600次/分，心室頻率400次/分，位置、方法及余處理同前組。(4)對照組：開胸暴露心臟后，未結(jié)扎冠脈或電刺激，余處理同前組。各組實驗前及實驗后2h、4h、6h、8h分別取頸靜脈血，用ELISA法檢測血漿BNP和肌酸激酶同工酶(CK-MB)。免疫組化法（IHC）檢測心臟不同部位BNP表達。 結(jié)果(1)各組心梗前BNP和CK-MB水平均無顯著性差異(P0.05)。(2)各組經(jīng)結(jié)扎冠脈或誘發(fā)心律失常后血BNP和CK-MB水平較梗死前明顯升高，和梗死的時間成正比。大面積心梗組升高最明顯，小面積心梗組次之，心律失常組BNP水平居第三，對照組無明顯升高。各組間差別均有顯著性(P0.01)。(3)各組心肌切片BNP陽性表達程度均有顯著性差異(P0.01)。大、小面積心梗組心室切片中胞核和胞漿中有大量BNP表達，且染色較深；對照組BNP在胞核和胞漿只有少量表達或不表達。各組BNP陽性表達程度：大面積心梗組＞小面積心梗組＞單純心律失常組＞對照組，各組間差別均有顯著性(P0.01)。單純心律失常組心房組織BNP表達多于其心室組織，差別具有顯著性(P0.01)，且房性心律失常發(fā)生率和BNP表達程度成正相關(guān)。 結(jié)論本研究結(jié)果顯示，兔急性心梗時房性快速型心律失常的發(fā)生與BNP水平關(guān)系密切。BNP水平越高，房性心律失常的發(fā)生率越高；同時單純心律失常心房組織的BNP表達多于心室組織，提示BNP的合成與分泌以心房組織為主。通過了解BNP水平可以預(yù)測急性心梗時房性快速型心律失常的發(fā)生。
[Abstract]:Objective to observe the effect of atrial tachyarrhythmia (ATS) on BNP in plasma and myocardium of rabbits with acute myocardial infarction (AMI).Methods 32 experimental rabbits were randomly divided into 4 groups: large area myocardial infarction group, small area myocardial infarction group, simple arrhythmia group, control group.If there was no arrhythmia, the electrophysiological stimulator was used to induce arrhythmia with S1S1 method, the frequency was 20 times per minute higher than that before stimulation, and the stimulation on the surface of the atrium and ventricle was 10 seconds each to induce arrhythmia.Ventricular frequency 400 times / min, position, method and remaining treatment group. 4) Control group: after open heart exposure, no ligation of coronary artery or electrical stimulation, the remaining treatment was the same as the former group.The jugular vein blood was collected before and 2 hours after the experiment, and the plasma BNP and creatine kinase isoenzyme (CK-MBP) were detected by ELISA method.Immunohistochemical method was used to detect the expression of BNP in different parts of the heart.Results 1) there was no significant difference in the levels of BNP and CK-MB in each group before myocardial infarction (P < 0.05). The levels of BNP and CK-MB in each group after ligation of coronary artery or induced arrhythmia were significantly higher than those before infarction, which were in direct proportion to the time of infarction.The increase of BNP was the most obvious in large area myocardial infarction group, followed by small area myocardial infarction group, the third in arrhythmia group, and no significant increase in control group.There was a significant difference in the expression of BNP in myocardial sections of each group (P 0.01).In the large and small area myocardial infarction group, there was a large amount of BNP expression in the nucleus and cytoplasm of ventricular sections, and the staining was deep, while in the control group, there was only a little or no expression of BNP in the nucleus and cytoplasm of the control group.The positive expression of BNP in each group was as follows: large area myocardial infarction group > small area myocardial infarction group > simple arrhythmia group > control group.In simple arrhythmia group, the expression of BNP in atrial tissue was higher than that in ventricular tissue, the difference was significant (P 0.01), and the incidence of atrial arrhythmia was positively correlated with the degree of BNP expression.Conclusion the results show that the higher the level of BNP, the higher the incidence of atrial tachyarrhythmia in acute myocardial infarction.At the same time, the expression of BNP in pure arrhythmia atrial tissue was higher than that in ventricular tissue, suggesting that the synthesis and secretion of BNP was mainly in atrial tissue.The level of BNP can predict the occurrence of atrial tachyarrhythmia in acute myocardial infarction.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R541.7;R542.22

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1 蘇毅;慕春言;馬欣;趙倡武;;左心衰竭合并心房纖顫患者血漿腦利鈉肽臨床觀察[J];實用心腦肺血管病雜志;2010年01期

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