摘要目的 观察慢性心力衰竭(CHF)大鼠室旁核内大电导钙激活钾通道(BKCa)的变化及其与交感神经活动的关系.方法 雄性Wistar大鼠,6～7周龄,随机数字表法分为2组,即假手术组和CHF组.通过结扎冠状动脉左前降支的方法建立大鼠CHF模型,假手术组仅穿线不结扎.建模术后2周,对大鼠行下丘脑室旁核慢性灌注BKCa选择性阻断剂IBTX术,取假手术组和CHF组大鼠各24只,进一步分成8个亚组,即假手术+溶剂人工脑脊液(aCSF)组、CHF+aCSF组、假手术+IBTX低剂量组、CHF+IBTX低剂量组、假手术+IBTX中剂量组、CHF+IBTX中剂量组、假手术+IBTX高剂量组和CHF+IBTX高剂量组,每组6只大鼠,IBTX低、中、高剂量分别为0.125、1.25、12.5 nmol/nl.另取建模术后2周大鼠,行下丘脑室旁核微量注射病毒术,取假手术组和CHF组大鼠各12只,进一步分成4个亚组,即假手术病毒对照组、假手术基因敲减KCNMB4组、CHF病毒对照组和CHF基因敲减KCNMB4组,每组6只大鼠.超高分辨率小动物超声实时影像系统测定各组大鼠心功能指标,包括左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)和左心室舒张末期内径(LVEDD)等.进一步对大鼠行右侧颈总动脉插管,通过PowerLab生物信号采集与分析系统,采集大鼠的平均动脉压(MAP)、左心室收缩压(LVSP)和左心室舒张末期压(LVEDP)等指标.在肾脏部位游离出肾交感神经,记录肾交感神经放电(RSNA),心电图采用标Ⅱ导联记录,同步得到心率.分别记录在药物或病毒干预后4周上述各指标变化.待超声心动图、血液动力学和肾交感神经记录结束后,经大鼠腹主动脉采血,ELISA法测定大鼠血浆去甲肾上腺素(NE)及血清N末端B型利钠肽原(NT-proBNP)水平.取血结束后取大鼠心脏及肺脏称重,计算右心室体重比和肺重比.对大鼠心脏进行伊文思蓝染色,计算大鼠心肌梗死面积.免疫荧光和Western blot法检测大鼠室旁核内KCNMB4蛋白表达量.实时荧光定量聚合酶链反应检测大鼠下丘脑室旁核BKCa基因表达量.结果 (1)抑制下丘脑室旁核BKCa功能对大鼠心功能、血液动力学、交感驱动和组织解剖学指标的影响:CHF+aCSF组及CHF+IBTX低剂量、中剂量和高剂量组大鼠LVEF和左心室短轴缩短率均明显低于相应的假手术各组(P均＜0.05),LVEDP均明显高于相应的假手术各组(P均＜0.05),左心室最大收缩速率(+dp/dt)均明显低于相应的假手术各组(P均＜0.05).假手术+IBTX中剂量和高剂量组大鼠肾交感神经放电和心率均明显高于假手术+aCSF组,假手术+IBTX低剂量、中剂量和高剂量组大鼠MAP和血浆NE水平均明显高于假手术+aCSF组(P均＜0.05).CHF+IBTX低剂量、中剂量和高剂量组大鼠肾交感神经放电和血浆NE水平明显高于CHF+aCSF组(P均＜0.05),CHF+IBTX中剂量和高剂量组大鼠MAP和心率均明显高于CHF+aCSF组(P均＜0.05).CHF+aCSF组及CHF+IBTX低剂量、中剂量和高剂量组大鼠右心室体重比和肺重比均明显高于相应的假手术各组(P均＜0.05).(2)CHF组大鼠下丘脑室旁核内KCNMB4基因及蛋白亚基表达量:CHF组大鼠下丘脑室旁核内KCNMB4 mRNA和蛋白表达量以及KCNMB4阳性神经元数量均明显少于假手术组(P均＜0.05).(3)下丘脑室旁核内KCNMB4敲减对大鼠交感驱动、心功能和组织解剖学指标的影响:微量注射病毒后4周,假手术基因敲减KCNMB4组和CHF病毒对照组大鼠的LVEDD均明显大于假手术病毒对照组(P均＜0.05),而CHF基因敲减KCNMB4组则进一步大于CHF病毒对照组(P＜0.05),假手术基因敲减KCNMB4组和CHF病毒对照组大鼠的LVEF和左心室短轴缩短率则均低于假手术病毒对照组(P均＜0.05),而CHF基因敲减KCNMB4组则进一步低于CHF病毒对照组(P＜0.05).假手术基因敲减KCNMB4组和CHF病毒对照组大鼠的LVSP和+dp/dt均明显低于假手术病毒对照组(P均＜0.05),而CHF基因敲减KCNMB4组上述指标则进一步低于CHF病毒对照组(P＜0.05),假手术基因敲减KCNMB4组和CHF病毒对照组大鼠的LVEDP明显高于假手术病毒对照组(P＜0.05),而CHF基因敲减KCNMB4组则进一步高于CHF病毒对照组(P＜0.05).假手术基因敲减KCNMB4组大鼠的MAP、肾交感神经放电、心率和血浆NE水平均明显高于假手术病毒对照组(P均＜0.05),而CHF基因敲减KCNMB4组上述指标则均高于假手术病毒对照组和CHF病毒对照组(P均＜0.05).假手术基因敲减KCNMB4组和CHF病毒对照组大鼠右心室体重比和肺重比均明显高于假手术病毒对照组(P均＜0.05),而CHF基因敲减KCNMB4组上述指标则进一步高于CHF病毒对照组(P均＜0.05).(4)下丘脑室旁核内KCNMB4敲减对KCNMB4蛋白亚基表达量的影响:假手术基因敲减KCNMB4组、CHF病毒对照组和CHF基因敲减KCNMB4组大鼠下丘脑室旁核内KCNMB4蛋白表达水平均明显低于假手术病毒对照组(P均＜0.05),且CHF基因敲减KCNMB4组进一步低于CHF病毒对照组(P＜0.05).结论 CHF大鼠室旁核内BKCa表达下调、功能钝化,而其可能参与介导了交感传出神经活动增强,与心衰状态下心功能进一步恶化有关.

abstractsObjective To elucidate the association between large conductance calcium-activated potassium channels (BKCa) in the paraventricular hypothalamic nucleus (PVN) and sympathetic outflow in rats with chronic heart failure (CHF).Methods Male Wistar rats (6-7 weeks old) were randomized to sham operated group and CHF group (coronary artery ligation).Two weeks after operation,BKCa inhibitor Iberiotoxin (IBTX) was infused into PVN by osmotic minipumps,rats were divided into following groups:sham + aCSF,CHF + aCSF,sham + low dose IBTX (0.125 nmol/nl),CHF + low dose IBTX,sham + moderate dose IBTX(1.25 nmol/nl),CHF+moderate dose IBTX,sham+ high dose IBTX (12.5 nmol/nl),and CHF+ high dose IBTX (n=6 each).Additional rats were grouped as follows:sham + vehicle,sham + KCNMB4 knockdown (by rAAV2-KCNMB4 shRNA virus injection in PVN),CHF + vehicle,CHF + KCNMB4 knockdown group (n=6 each).The cardiac function was determined by echocardiography,left ventricular hemodynamics were measured invasively,renal sympathetic nerve activity (RSNA) was recorded at 6 weeks after coronary artery ligation or sham operation.The contents of norepinephrine (NE) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in plasma were determined by enzyme-linked immunosorbent assay.The protein and mRNA expression of KCNMB4 in PVN were measured by immunofluorescence staining,Western blot,and real-time PCR,mRNA expression of BKCa in PVN was detected by real-time PCR.Results Compared with the sham operation group,the cardiac function of the heart failure group was significantly reduced (P＜0.05),and the plasma NE and the serum NT-proBNP were significantly elevated (P＜0.05).The protein and mRNA expression of KCNMB4 in PVN were obviously down-regulated in CHF rats (P＜0.05).After perfusion of IBTX or KCNMB4 knockdown by microinjection of rAAV2-KCNMB4 shRNA virus,right ventricular weight/body weight and lung weight/body weight ratio as well as left ventricular end-diastolic diameter were increased and left ventricular ejection fraction was decreased (all P＜0.05),the sympathetic driving indexes was increased in sham rats,changes of these parameters further aggravated in CHF rats (P＜0.05).KCNMB4 knockdown further downregulated protein expression in PVN of CHF rats.Conclusion Downregulation and blunted function of BKCa in PVN may contribute to sympathoexcitation and deterioration of cardiac function in rats with chronic heart failure.