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目的研究高血压非瓣膜心房颤动患者甲状腺激素受体(TR)的活性差异,以探讨此类患者心房颤动发生发展的可能机制。方法 2008年1月-2010年1月序贯收集103例高血压非瓣膜心房颤动患者的相关资料(48例阵发性心房颤动、55例持续性心房颤动),并收集50例单纯高血压患者。收集各组患者的相关人口学数据及检查结果,并采用放射性分析技术测定各组患者外周血淋巴细胞及淋巴细胞核TR的活性,主要包括平衡解离常数(Kd)及最大结合容量(MBC)。结果心房颤动患者淋巴细胞TR的Kd较单纯高血压患者小(越小表示与甲状腺激素的亲和力越高),且持续性心房颤动患者的Kd较阵发性心房颤动患者更小(0.77±0.43、1.02±0.41,P<0.001);心房颤动患者淋巴细胞TR的MBC较单纯高血压患者小(越小表示受体总量越少),且持续性心房颤动患者TR的MBC较阵发性心房颤动患者更小(36.10±12.40、65.22±30.90,P<0.001)。淋巴细胞核TR的Kd及MBC也存在类似情况。简单相关分析提示左房直径与淋巴细胞TR的Kd及MBC呈负相关,另外,调整相关指标后偏相关分析也提示左房直径与Kd及MBC呈负相关(Kd:r=0.296,MBC:r=0.448;P均<0.01);淋巴细胞核TR的Kd及MBC也存在类似情况。结论高血压非瓣膜心房颤动患者中,TR的总量减少,并且持续心房颤动组低于阵发心房颤动组;甲状腺激素与受体的亲和力在心房颤动患者中升高,且持续心房颤动组高于阵发心房颤动组。另外,还发现TR的Kd和MBC与左房直径均呈负相关。这些改变可能是高血压非瓣膜心房颤动患者心房颤动发生及维持的一种重要机制。
Objective To investigate the differences of thyroid hormone receptor (TR) activity in hypertensive patients with non-valvular atrial fibrillation (FNA) to explore the possible mechanism of the occurrence and development of atrial fibrillation. Methods The data of 103 patients with non-valvular atrial fibrillation (48 cases of paroxysmal atrial fibrillation and 55 cases of persistent atrial fibrillation) were collected from January 2008 to January 2010 and 50 patients with simple hypertension . The demographic data and test results of each group were collected. Radioimmunoassay was used to determine the activity of TR in peripheral blood lymphocytes and lymphocytes in each group, including the Kd and MBC. Results The Kd of lymphocyte TR in patients with atrial fibrillation was smaller than that of patients with simple hypertension (the smaller is the affinity with thyroid hormone), and the Kd in patients with persistent atrial fibrillation was smaller than that in patients with paroxysmal atrial fibrillation (0.77 ± 0.43, 1.02 ± 0.41, P <0.001). The MBC of lymphocyte TR in patients with atrial fibrillation was smaller than that of patients with simple hypertension (the smaller the smaller the total number of recipients), and the MB in patients with persistent atrial fibrillation was higher than that in patients with paroxysmal atrial fibrillation Patients were smaller (36.10 ± 12.40,65.22 ± 30.90, P <0.001). A similar situation exists for the Kd and MBC of lymphocyte nuclear TR. Simple correlation analysis showed that left atrial diameter was negatively correlated with Kd and MBC of lymphocytes in TR. In addition, partial correlation analysis also showed that left atrial diameter was negatively correlated with Kd and MBC (Kd: r = 0.296, MBC: r = 0.448; P <0.01). There was also similar Kd and MBC in lymphocyte nuclear TR. CONCLUSION: The total amount of TR decreased in patients with non-valvular atrial fibrillation, and the persistent atrial fibrillation group was lower than that of paroxysmal atrial fibrillation group. The affinity of thyroid hormone and receptor increased in patients with atrial fibrillation and sustained high atrial fibrillation In paroxysmal atrial fibrillation group. In addition, Kd and MBC of TR were also found to be negatively correlated with left atrial diameter. These changes may be an important mechanism for the occurrence and maintenance of atrial fibrillation in patients with non-valvular atrial fibrillation.