高血压非瓣膜心房颤动患者甲状腺激素受体活性的变化  

Changes of Thyroid Hormone Receptor Activity in Patients with Hypertensive Non-valvular Atrial Fibrillation

作　　者：王斯[1] 何森[1] 陈晓平[1] 万里艳[1] 李龙心[1] 

机构地区：[1]四川大学华西医院心血管内科,成都610041

出　　处：《华西医学》2012年第4期512-516,共5页West China Medical Journal

摘　　要：目的研究高血压非瓣膜心房颤动患者甲状腺激素受体(TR)的活性差异,以探讨此类患者心房颤动发生发展的可能机制。方法 2008年1月-2010年1月序贯收集103例高血压非瓣膜心房颤动患者的相关资料(48例阵发性心房颤动、55例持续性心房颤动),并收集50例单纯高血压患者。收集各组患者的相关人口学数据及检查结果,并采用放射性分析技术测定各组患者外周血淋巴细胞及淋巴细胞核TR的活性,主要包括平衡解离常数(Kd)及最大结合容量(MBC)。结果心房颤动患者淋巴细胞TR的Kd较单纯高血压患者小(越小表示与甲状腺激素的亲和力越高),且持续性心房颤动患者的Kd较阵发性心房颤动患者更小(0.77±0.43、1.02±0.41,P<0.001);心房颤动患者淋巴细胞TR的MBC较单纯高血压患者小(越小表示受体总量越少),且持续性心房颤动患者TR的MBC较阵发性心房颤动患者更小(36.10±12.40、65.22±30.90,P<0.001)。淋巴细胞核TR的Kd及MBC也存在类似情况。简单相关分析提示左房直径与淋巴细胞TR的Kd及MBC呈负相关,另外,调整相关指标后偏相关分析也提示左房直径与Kd及MBC呈负相关(Kd:r=0.296,MBC:r=0.448;P均<0.01);淋巴细胞核TR的Kd及MBC也存在类似情况。结论高血压非瓣膜心房颤动患者中,TR的总量减少,并且持续心房颤动组低于阵发心房颤动组;甲状腺激素与受体的亲和力在心房颤动患者中升高,且持续心房颤动组高于阵发心房颤动组。另外,还发现TR的Kd和MBC与左房直径均呈负相关。这些改变可能是高血压非瓣膜心房颤动患者心房颤动发生及维持的一种重要机制。Objective To investigate the changes of thyroid hormone receptor（TR） activity in hypertensive non-valvular atrial fibrillation（AF） patients so as to elucidate the possible mechanism underlying the genesis and development of AF in these patitients.Methods By using a case-control study design,103 patients with hypertensive AF（paroxysmal AF： 48,persistent AF： 55） from January 2008 to January 2010 were included in the study.A total of 50 age-matched hypertensive patients without AF were selected as the controls.Demographic data and laboratory parameters of each group were collected.TR activity,including dissociation constant（Kd） and maximun binding capacity（MBC） of peripheral blood lymphocytes and their nucleus were measured by radioligand method.Results The Kd of peripheral blood lymphocyte TR was lower in the hypertensive AF group than in the hypertensive non-AF group,and it was significantly lower in persistent AF patients than in paroxysmal AF patients（36.10 ± 12.40,65.22 ± 30.90;P〈0.001）.The MBC was markedly lower in the hypertensive AF group compared with the hypertensive non-AF group,and it was also significantly lower in persistent AF patients than in patients with paroxysmal AF（0.77 ± 0.43,1.02 ± 0.41;P〈0.001）.Kd and MBC of nucleus also had the same phenomena.The Kd and MBC of peripheral blood lymphocyte TR were in negative correlation with left atrial diameter（LAD） by using simple correlation analysis.After adjustment of some clinical parameters,the partial coefficient was ？0.296 for Kd and ？0.448 for MBC,respectively（P〈0.01）.Kd and MBC of nucleus were also in negative correlation with LAD.Conclusions In hypertensive AF patients,the amount of TR is lower.Compared with the hypertensive non-AF patients,the affinity of TR is higher.The amount of TR is less,while the affinity of TR is higher in persistent AF patients than in paroxysmal AF patients.Furthermore,Kd and MBC of TR are in negative correlation with LAD.These changes might be important mechnisms und

关 键 词：高血压 非瓣膜心房颤动 甲状腺激素受体活性 

分 类 号：R541.75[医药卫生—心血管疾病]