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目的研究慢性心房颤动(房颤)患者心房内皮型一氧化氮合成酶(eNOS)、纤溶酶原激活剂抑制物1(PAI1)蛋白表达和血浆一氧化氮(NO)、PAI1、血管性血友病因子(vWF)含量的变化,探讨房颤血栓形成的可能机制。方法30例风湿性心脏病二尖瓣病变接受外科手术者,分为窦性心律组、阵发性房颤组和慢性房颤组,手术时取左右心房组织各100mg,通过Westernblot检测eNOS和PAI1蛋白表达数量,免疫组织化学方法检测蛋白表达位置,酶联免疫吸附双抗体夹心法检测血浆PAI1和vWF水平,硝酸还原酶法测定血浆NO浓度。结果慢性房颤组和阵发性房颤组左心房eNOS蛋白表达明显下调,PAI-1蛋白表达上调,右心房无显著变化。慢性房颤组血浆vWF明显高于阵发性房颤组,阵发性房颤组明显高于窦性心律组;慢性房颤组和阵发性房颤组血浆PAI-1明显高于窦性心律组,NO明显低于窦性心律组。结论房颤能引起左心房心内膜功能受损,导致抗血栓物质eNOS蛋白表达下调,促血栓物质PAI1蛋白表达上调,血栓形成与溶解平衡失调,这可能是房颤左心房血栓形成的重要原因。
Objective To investigate the expression of atrial endothelial nitric oxide synthase (eNOS) and plasminogen activator inhibitor 1 (PAI1) in patients with chronic atrial fibrillation (AF) and the levels of plasma nitric oxide (NO), PAI1, To investigate the possible mechanism of thrombus formation in atrial fibrillation (VWF). Methods Thirty patients with rheumatic mitral valve disease undergoing rheumatic heart disease were divided into sinus rhythm group, paroxysmal atrial fibrillation group and chronic atrial fibrillation group. 100 mg of left and right atrial tissues were obtained during operation. The eNOS and PAI1 The expression of PAI1 and vWF were detected by enzyme-linked immunosorbent assay (ELISA) and plasma NO levels by nitrate reductase method. Results The expression of eNOS protein in left atria of chronic atrial fibrillation group and paroxysmal atrial fibrillation group were significantly down-regulated while the expression of PAI-1 protein was up-regulated. There was no significant change in right atrium. Plasma vWF in chronic atrial fibrillation group was significantly higher than that in paroxysmal atrial fibrillation group, and in paroxysmal atrial fibrillation group was significantly higher than that in sinus rhythm group; PAI-1 in chronic atrial fibrillation group and paroxysmal atrial fibrillation group was significantly higher than that in sinus Heart rate group, NO was significantly lower than sinus rhythm group. Conclusion Atrial fibrillation can cause impairment of left atrial endocardial function, leading to the down-regulation of eNOS protein, anti-thrombotic substance PAI1, upregulation of thrombotic substance, imbalance of thrombosis and lysis, which may be the important reason of atrial fibrillation in left atrial thrombosis .