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目的观察心力衰竭患者M2乙酰胆碱能受体的自身抗体(Abs)阳性血清以及M2乙酰胆碱能受体激动剂碳酰胆碱对心肌细胞的影响。方法应用全细胞钳制技术,定量观察并比较碳酰胆碱和心力衰竭患者Abs阳性血清对豚鼠单个心室肌细胞的L型钙电流强度的影响。结果M2受体激动剂碳酰胆碱使预先由异丙肾上腺素增大的L型钙电流峰值电流强度和标准电流密度从(2111.65±203.13)pA和(18.83±1.14)pA/pF下降为(1230.87±208.14)pA(P<0.01)和(10.72±1.06)pA/pF(P<0.01),M2受体阻滞剂阿托品可以阻断碳酰胆碱的这一作用。同样,心力衰竭患者的Abs阳性血清能使L型钙电流的峰值电流强度由(1995.21±195.13)pA下降至(636.42±110.07)pA,P<0.01,标准电流密度由(18.13±1.03)pA/pF下降至(5.54±0.81)pA/pF,P<0.01;阿托品也可阻断此作用。结论心力衰竭患者Abs阳性血清对豚鼠心室肌细胞的作用与碳酰胆碱相似,对心肌细胞M2受体有“激动剂样”效应,能使心肌细胞的L型钙电流减小,产生负性肌力作用;阿托品可以阻断它们对豚鼠心室肌细胞的作用。
Objective To observe the effects of M2-positive serum of M2 acetylcholine receptor and carbonyl acetylcholine receptor of M2 acetylcholine receptor on cardiomyocytes in patients with heart failure. Methods Whole-cell clamp technique was used to quantitatively observe and compare the effect of Abs-positive serum in patients with carbachol and heart failure on the L-type calcium current in guinea pig single ventricular myocytes. Results The M2 receptor agonist carbachol decreased the L-type calcium current peak current intensity and standard current density previously increased from (2111.65 ± 203.13) pA and (18.83 ± 1.14) pA / pF to ( 1230.87 ± 208.14) pA (P <0.01) and (10.72 ± 1.06) pA / pF (P <0.01). The M2 antagonist atropine could block the effect of carbachol. Similarly, Abs positive serum in patients with heart failure decreased peak current intensity of L-type calcium current from (1995.21 ± 195.13) pA to (636.42 ± 110.07) pA, P <0.01 and standard current density from (18.13 ± 1.03) pA / pF decreased to (5.54 ± 0.81) pA / pF, P <0.01; atropine can also block this effect. Conclusion Abs-positive sera from patients with heart failure have the same effect as carbachol on guinea pig ventricular myocytes, and have “agonist-like” effect on M2 receptor of cardiomyocytes, which can decrease the L-type calcium current of cardiomyocytes and produce negative Atropine blocks their effects on ventricular myocytes in guinea pigs.