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目的探讨风湿性心脏病伴慢性心房颤动(Af)患者心房组织内肾素血管紧张素系统(RAS)活性与血栓前状态(PLS)的关系。方法将38例接受手术的风湿性心脏病患者分为慢性Af组和窦性心律组,对两组患者均采用比浊法测定脂蛋白(a)[Lip(a)],ELISA法检测Ⅷ因子相关抗原vWFAg、血小板α颗粒膜蛋白140(GMP140)和D二聚体(Ddimer),免疫印迹(Westernblotting)法检测心房组织血管紧张素转化酶(ACE)的水平,非平衡放射免疫测定法测定血管紧张素Ⅱ(AngⅡ)含量。结果慢性Af组Lip(a)、vWFAg、GMP140和Ddimer的水平均较窦性心律组明显增高(P<0.01、0.05);心房组织AngⅡ的水平明显高于窦性心律组(P<0.01);ACE表达量也较窦性心律组明显增加(P<0.01);相关分析显示,心房组织AngⅡ水平与Lip(a)、vWFAg、GMP140和Ddimer均呈正相关(r分别为0.86、0.64、0.93和0.61,P<0.01或P<0.05)。结论风湿性心脏病伴慢性Af患者存在PLS以及心房组织局部RAS的激活,心房组织局部RAS的激活可能是其存在PLS的发生机制之一。
Objective To investigate the relationship between renin-angiotensin system (RAS) activity and pre-thrombotic state (PLS) in patients with rheumatic heart disease and chronic atrial fibrillation (Af). Methods Thirty-eight patients with rheumatic heart disease undergoing surgery were divided into chronic Af group and sinus rhythm group. Lipase (a) [Lip (a)] was determined by turbidimetry in both groups, The levels of angiotensin-converting enzyme (ACE) in atrial tissue were detected by Western blotting with the related antigen vWFAg, GMP140 and D-dimer, and the blood vessels were measured by non-equilibrium radioimmunoassay Angiotensin Ⅱ (Ang Ⅱ) content. Results The levels of Lip (a), vWFAg, GMP140 and Ddimer in chronic Af group were significantly higher than those in sinus rhythm group (P <0.01, 0.05). The Ang Ⅱ level in atrial tissue was significantly higher than that in sinus rhythm group (P <0.01) (P <0.01). Correlation analysis showed that there was a positive correlation between Ang Ⅱ level and Lip (a), vWFAg, GMP140 and Ddimer in atria (r = 0.86,0.64,0.93 and 0.61 , P <0.01 or P <0.05). Conclusions There is PLS and local RAS activation in chronic Af patients with rheumatic heart disease, and the activation of local RAS in atrial tissue may be one of the mechanisms of PLS.