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目的探讨心房颤动患者心房肌组织盐皮质激素受体(MR)和赋予 MR 特异性的关键酶11β-羟基类固醇脱氢酶Ⅱ(11βHSD2)的 mRNA 和蛋白表达改变。方法入选进行人工心脏瓣膜置换术的风湿性心脏病患者25例,其中窦性心律12例,慢性心房颤动(心房颤动时程≥6月)13例。术前进行经胸超声心动图检查,所有患者在术前均签订知情同意书,于手术时取左右心房侧壁组织。用实时荧光定量 PCR 检测 MR 和11βHSD2的 mRNA 水平,Western 印迹检测 MR 和11βHSD2的蛋白表达改变。结果心房颤动组比窦性心律组左房内径显著扩大(P<0.01);房颤组患者 MR mRNA表达(右房:5.37±1.15 vs 2.67±1.09,左房:5.19±1.14 vs 2.70±0.82 P 均<0.01)和11βHSD2mRNA 表达(右房:0.86±0.14 vs 0.33±0.12,左房:0.95±0.15 vs 0.37±0.10 P 均<0.01)均明显增加;同时房颤组患者 MR 和11βHSD2蛋白表达也较窦性心律者明显增加,MR 分别为右房:1.65±0.72 vs 0.86±0.33(P<0.01);左房:1.72±0.62 vs 0.97±0.37(P<0.05)。11βHSD2分别为右房:-1.18±0.64 vs 0.71+0.21(P<0.01);左房:1.36±0.58 vs 0.85±0.15(P<0.05);但在左右心房之间无论是在窦性心律或心房颤动时,MR 和11βHSD2二者在 mRNA 水平和蛋白表达水平差异均无统计学意义(P>0.05)。结论心房颤动时心房肌组织 MR 和11βHSD2表达增加,醛固酮受体拮抗剂将可能对心房颤动发挥治疗作用。
Objective To investigate the changes of mRNA and protein expression of mineralocorticoid receptor (MR) and 11β-hydroxysteroid dehydrogenase Ⅱ (11βHSD2), which is specific to MR in atrial fibrillation patients. Methods Twenty-five patients with rheumatic heart disease undergoing heart valve replacement were enrolled, including 12 cases of sinus rhythm and 13 cases of chronic atrial fibrillation (atrial fibrillation ≥ 6 months). Preoperative transthoracic echocardiography, all patients were signed before informed consent, at surgery to take around the atrial wall tissue. The mRNA levels of MR and 11βHSD2 were detected by real-time fluorescence quantitative PCR, and the protein expression of MR and 11βHSD2 was detected by Western blotting. Results Compared with sinus rhythm group, the atrial diameter of left atrium was significantly increased in atrial fibrillation group (P <0.01). MR mRNA expression in atrial fibrillation group (right atrium: 5.37 ± 1.15 vs 2.67 ± 1.09, left atrium: 5.19 ± 1.14 vs 2.70 ± 0.82 P (P <0.01) and 11βHSD2mRNA expression (right atrium: 0.86 ± 0.14 vs 0.33 ± 0.12, left atrium: 0.95 ± 0.15 vs 0.37 ± 0.10 P <0.01) .At the same time, MR and 11βHSD2 protein expression in patients with atrial fibrillation Sinus rhythm increased significantly, MR were right atrium: 1.65 ± 0.72 vs 0.86 ± 0.33 (P <0.01); left atrium: 1.72 ± 0.62 vs 0.97 ± 0.37 (P <0.05). 11βHSD2 were right atrium: -1.18 ± 0.64 vs 0.71 + 0.21 (P <0.01); left atrium: 1.36 ± 0.58 vs 0.85 ± 0.15 (P <0.05); but in the left atrium, There was no significant difference between MR and 11βHSD2 mRNA and protein levels in fibrillation (P> 0.05). Conclusion Atrial fibrillation MR and 11βHSD2 expression increased, aldosterone receptor antagonist may play a therapeutic role in atrial fibrillation.