裴德安, 李莉, 徐志云, 黄进宇, 徐正明, 王敏, 姚强, 黄世恩, 黄琪. 心房颤动患者心房组织醛固酮和心房基质重构研究[J]. 心脏杂志, 2009, 21(1): 41-45.
    引用本文: 裴德安, 李莉, 徐志云, 黄进宇, 徐正明, 王敏, 姚强, 黄世恩, 黄琪. 心房颤动患者心房组织醛固酮和心房基质重构研究[J]. 心脏杂志, 2009, 21(1): 41-45.
    shu
    Atrial tissue aldosterone level and atrial extracellular matrix remodeling in patients with atrial fibrillation[J]. Chinese Heart Journal, 2009, 21(1): 41-45.
    Citation: Atrial tissue aldosterone level and atrial extracellular matrix remodeling in patients with atrial fibrillation[J]. Chinese Heart Journal, 2009, 21(1): 41-45.
    shu

    心房颤动患者心房组织醛固酮和心房基质重构研究

    Atrial tissue aldosterone level and atrial extracellular matrix remodeling in patients with atrial fibrillation

      摘要
    • 摘要: 目的 探讨心房颤动患者心房组织醛固酮水平和心房基质重构的相关关系。方法 入选行人工瓣膜置换术的风湿性心脏病患者25例，其中窦性心律者12例，慢性心房颤动者（房颤时程≥6月）13例。术前进行经胸超声心动图检查并留取有关资料，于手术时取左右心房侧壁组织，用放射免疫法测定心房组织醛固酮水平；用VG染色法对总胶原容量分数（CVF）半定量分析；RT-PCR检测Ⅰ型和Ⅲ型胶原mRNA表达改变。结果 与窦性心律者比较心房颤动组左房内径显著扩大（均P<0.01）；心房肌组织醛固酮［右房：(310.3±69.6) vs (154.5±35.8)pg/g,左房：(334.2±76.6) vs (166.5±38.6)pg/g，均P<0.01］、Ⅰ型胶原mRNA表达［右房：(1.95±0.22) vs (0.71±0.11)，左房：(2.05±0.28) vs (0.74±0.16),均P<0.01］和CVF［右房：(13.0±1.9)％ vs (6.5±1.1)％，左房：(14.1±1.7)％ vs (6.7±1.2)％，均P<0.01］均明显增加；Ⅲ型胶原mRNA表达在房颤组和窦性心律组间无差异；上述指标在左、右心房之间无差异。Ⅰ型胶原mRNA与左心房直径（r＝0.885，P<0.01）、CVF和左心房直径（r＝0.845，P<0.01）均显著正相关；心房组织醛固酮水平与左心房内径（r＝0.814，P<0.01）和CVF（r＝0.885，P<0.01）均呈明显正相关。结论 心房组织醛固酮水平可能在心房颤动心房基质重构中起重要作用，并可能参与了心房颤动的发生和维持。

       

      Abstract: AIM To investigate atrial tissue aldosterone level and atrial extracellular matrix remodeling in patients with atrial fibrillation and to evaluate the effects of aldosterone on the progress of atrial structural remodeling. METHODS Twenty-five patients with rheumatic heart valve disease, 12 in sinus rhythm and 13 in chronic atrial fibrillation (≥6 months), underwent transthoracic echocardiography and right and left atrial lateral wall tissue samples were obtained from these patients during mitral/aortic valve replacement operation. Radioimmunoassay was used to determine tissue aldosterone level in local atria. The mRNA expression of Type Ⅰor Ⅲ collagen and total collagen volume fraction (CVF) were analyzed by RT-PCR and VG staining respectively. RESULTS The left atrial diameters increased markedly in the atrial fibrillation as compared to sinus rhythm (P<0.01). The results suggested that atrial tissue aldosterone level \(310.3±69.6) vs (154.5±35.8) pg/g in right atria, (334.2±76.6) vs (166.5±38.6) pg/g in left atria, both P<0.01\, the mRNA expression of TypeⅠcollagen \(1.95±0.22) vs (0.71±0.11) in right atria, (2.05±0.28) vs (0.74±0.16) in left atria, both P<0.01) and total CVF \(13.0±1.9)％ vs (6.5±1.1)％ in right left, (14.1±1.7)％ vs (6.7±1.2)％ in left atria, both P<0.01) all increased significantly in atrial fibrillation groups compared with those in sinus rhythm, whereas the mRNA expression of type Ⅲ collagen remained compatible within groups. No significant difference was found in aldosterone, the mRNA expression of typeⅠcollagen and total CVF between left atria and right atria both in fibrillation and sinus groups. There were significant positive correlation between typeⅠ collagen mRNA expression and left atrial dimension, CVF and left atrial dimension, and the correlation coefficient r was 0.885 and 0.845 respectively (both P<0.01). Tissue aldosterone in local atria also significantly was correlated with left atrial dimension（r＝0.814， P<0.01） and CVF（r＝0.885， P<0.01）. CONCLUSION Aldosterone in local atria may promote the process of atrial matrix remodeling and probably participate in the mediation and persistence of atrial fibrillation.

       

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