缬沙坦对风心病房颤患者心房结构重构的影响及其机制研究  

Effection of Valsartan on atrial structural remodeling and study on the mechanism with Patient of atrial fibrillaton

作　　者：阮宏云[1] 宫海滨 侍作胜[1] 张开广[3] 李先进[1] 

机构地区：[1]江苏徐州市中心医院心内科 [2]江苏徐州市心血管病研究所 [3]江苏徐州市中心医院心外科

出　　处：《中国分子心脏病学杂志》2011年第6期324-327,共4页Molecular Cardiology of China

基　　金：江苏徐州市科技局资助项目(项目编号:63)

摘　　要：目的通过观察缬沙坦对风湿性心脏病房颤患者心房结构重构以及心房肌细胞凋亡指数(AI)影响,以探讨结构重构发生的分子生物学机制。方法选取51例风心病二尖瓣狭窄伴永久性房颤接受开胸换瓣手术者,共分为两组:对照组(常规药物治疗)23例;试验组(缬沙坦干预组)28例,所有患者在行外科手术前常规行超声心动图检查;以免疫印迹方法半定量检测心房肌中p38MAPK、AT1R及AT2R;以TUNEL法检测细胞凋亡,计算凋亡指数(AI)。结果与对照组相比,试验组左右心房均明显减小,尤以左心房明显,具有统计学差异(P<0.01)。试验组的p38MAPK含量及AT1R的含量减少(P<0.01);AT2R的含量则增加(P<0.01)。对照组患者凋亡指数明显高于试验组,具有统计学差异(P<0.01),而且与左房内径大小呈正相关(r=0.86,P<0.01)。结论风湿性心脏病房颤患者心房结构重构时心房肌细胞凋亡与p38MAPK通路相关,缬沙坦可以减缓心房肌细胞凋亡。Objective To explore the molecular biological mechanism of structural remodeling and the effection of Valsartan on atrial fibrillation(AF). Methods 51 rheunatic heart disease(RHD) complicated with AF patients undergoing valve replacement were enrolled in this study , including 23 patients taking the regular drug , 28 taking Valsartan and the regular drug .Before surgery, each patient’s figures of LAd, RAd, LVDd and LVEF were measured by ultrasonic cardiograph . The atrial samples were obtained during surgery for Western blotting to detect the p38 mitogen-activated protein kinase (p38MAPK)、AT1R and AT2R protein expression, and their apoptosis index were detected by TUNEL. Results Compared with the control group ,the patients taking Valsartan showed decreased p38MAPK、AT1R protein expression(P<0.01)and increased AT2R protein expression(P<0.01)in the atrium. Also the apoptosis index was showed decreased of patients taking Valsartan (P<0.01).There are positively correlation between the apoptosis index and the left atrium dimension. Conculusion p38MAPK have been shown to play an important role in cellular apoptosis of patients with atrial fibrillation,and Valsartan may inverse the structural remodeling.

关 键 词：心房颤动 细胞凋亡 结构重构 P38MAPK 

分 类 号：R541.75[医药卫生—心血管疾病] R541.2[医药卫生—内科学]