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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。
Objective To investigate the relationship between atrial tissue aldosterone level and atrial matrix remodeling in patients with atrial fibrillation. Methods Twenty-five patients with rheumatic heart disease undergoing prosthetic valve replacement were enrolled, including 12 patients with sinus rhythm and 13 patients with chronic atrial fibrillation (duration ≥ 6 months). Preoperative transthoracic echocardiography and retention of relevant information, at the time of surgery to take atrial tissue around the atrium, radioimmunoassay determination of aldosterone levels of atrial tissue; VG staining of the total collagen volume fraction (CVF) semi-quantitative analysis The mRNA expression of type I and type III collagen was detected by RT-PCR. Results Compared with sinus rhythm, the left atrial diameter of atrial fibrillation group was significantly increased (all P <0.01); aldosterone [right atrium: (310.3 ± 69.6) vs (154.5 ± 35.8) pg / g, (1.95 ± 0.22) vs (0.71 ± 0.11), left atrium (2.05 ± 0.28) vs (166.5 ± 38.6) pg / g, P <0.01] (P <0.01) and CVF (right atrium: (13.0 ± 1.9)% vs (6.5 ± 1.1)%, left atrium: (14.1 ± 1.7) vs (6.7 ± 1.2)%, P < 0.01] were significantly increased; type Ⅲ collagen mRNA expression in atrial fibrillation group and sinus rhythm group no difference; these indicators no difference between the left and right atrium. Collagen type Ⅰ mRNA was positively correlated with left atrial diameter (r = 0.885, P <0.01), CVF and left atrial diameter (r = 0.845, P <0.01) P <0.01) and CVF (r = 0.885, P <0.01). Conclusion Atrial aldosterone level may play an important role in the atrial fibrillation remodeling and may be involved in the occurrence and maintenance of atrial fibrillation.