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目的探讨心房颤动(房颤)患者心房肌组织醛固酮水平和醛固酮合成酶基因CYP11B2 mRNA表达与房颤时心房结构重构的关系。方法入选进行人工心脏瓣膜置换术的风湿性心脏瓣膜病患者25例,其中窦性心律者12例,慢性房颤(≥6个月)者13例。上述患者均于术前行经胸超声心动图检查并留取相关资料,于手术时同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染色法对胶原容量分数(CVF)半定量分析;实时荧光定量PCR测定CYP11B2 mRNA在心房肌组织中的表达情况。结果与窦性心律组比较,房颤组左心房内径显著扩大(P<0．01);心房肌组织醛固酮水平和CVF均明显增加(P均<0．001);心房肌组织CYP11B2 mRNA表达也明显增加(P< 0．001);上述指标无论是在窦性心律时还是在房颤时其在左右心房之间差异无统计学意义(P均> 0．05)。CVF和左心房内径显著正相关(r=0．845,P<0．001);心房组织醛固酮水平与左心房内径(r= 0．814,P<0．001)和CVF(r=0．885,P<0．001)均呈明显正相关;CYP11B2 mRNA表达量和CVF亦呈明显正相关(r=0．757,P<0．001)。结论心房颤动时心房结构重构与其组织醛固酮水平增加和CYP11B2 mRNA表达增加有关,醛固酮受体拮抗剂可能在阻止房颤的心房结构重构进程上发挥治疗作用。
Objective To investigate the relationship between the level of aldosterone and the expression of aldosterone synthase gene CYP11B2 mRNA in atrial fibrillation (AF) patients and the remodeling of atrial structure during atrial fibrillation. Methods Twenty-five patients with rheumatic valvular heart disease undergoing artificial heart valve replacement were enrolled. Among them, 12 were sinus rhythm and 13 were chronic atrial fibrillation (≥6 months). All of the above patients underwent transthoracic echocardiography preoperatively and the relevant data were collected. At the same time, the left and right atrial wall tissues were taken during operation. The levels of aldosterone in the atria were measured by radioimmunoassay. Semiquantitative analysis of collagen volume fraction (CVF) by VG staining and the expression of CYP11B2 mRNA in atrial myocardium were performed by real-time fluorescence quantitative PCR. Results Compared with sinus rhythm group, the diameter of left atrium in atrial fibrillation group was significantly increased (P <0.01), aldosterone level and CVF in atrial fibrillation group were significantly increased (all P <0.001), and the expression of CYP11B2 mRNA in atrial fibrillation (P <0.001). There was no significant difference in the above indexes between left and right atrium in either sinus rhythm or atrial fibrillation (P> 0.05). There was a significant positive correlation between CVF and the diameter of the left atrium (r = 0.845, P <0.001). The level of aldosterone in the atria was correlated with the diameter of the left atrium (r = 0.814, P <0.001) 885, P <0.001). CYP11B2 mRNA expression was positively correlated with CVF (r = 0.757, P <0.001). Conclusions Atrial structural remodeling is associated with increased levels of aldosterone and increased expression of CYP11B2 mRNA in atrial fibrillation. Aldosterone receptor antagonists may play a therapeutic role in preventing atrial fibrillation during atrial remodeling.