TGF-β、MMPs和TIMPs在风湿性心脏病二尖瓣狭窄合并持续性房颤中的作用  

Role of TGF-β,MMPs and TIMPs in persistent atrial f ibrillation associated with rheumatic mitral stenosis

作　　者：盛炜[1] 李力兵[1] 陆江阳[2] 

机构地区：[1]北京解放军总医院心血管外科,100853 [2]北京解放军总医院第一附属医院病理科,100036

出　　处：《解放军医学杂志》2014年第8期614-617,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨转化生长因子β1(TGF-β1)、基质金属蛋白酶2(MMP-2)、MMP-9和金属蛋白酶组织抑制因子2(TIMP-2)在风湿性心脏病二尖瓣狭窄合并持续性房颤发生和发展中的作用。方法选取2011年8月-2013年12月在解放军总医院行二尖瓣置换术的风湿性心脏病二尖瓣重度狭窄患者39例,其中风湿性心脏病二尖瓣狭窄窦性心律患者15例(窦性心律组),风湿性心脏病二尖瓣狭窄伴阵发性房颤患者10例(阵发房颤组),风湿性心脏病二尖瓣狭窄合并持续性房颤患者14例(慢性房颤组)。术中取患者左心耳心肌标本,采用Masson染色观察心房肌组织纤维化程度,RT-PCR检测心房心肌组织TGF-β1、MMP-2、MMP-9和TIMP-2 mRNA表达情况。结果慢性房颤组和阵发房颤组的胶原容积分数(CVF)明显大于窦性心律组(P<0.01),且慢性房颤组CVF明显大于阵发房颤组(P<0.01)。慢性房颤组和阵发房颤组的TGF-β1、MMP-2、MMP-9 mRNA表达水平均显著高于窦性心律组(P<0.05,P<0.01),且慢性房颤组显著高于阵发房颤组(P<0.05,P<0.01)。慢性房颤组和阵发房颤组的TIMP-2 mRNA表达水平显著低于窦性心律组(P<0.05,P<0.01),且慢性房颤组显著低于阵发性房颤组(P<0.05,P<0.01)。结论 TGF-β1、MMP-2、MMP-9和TIMP-2可能参与了风湿性心脏病二尖瓣狭窄患者的心肌纤维化过程,在房颤的发生和发展中扮演重要角色。Objective To investigate roles of transforming growth factor β1 （TGF-β1）, matrix metalloproteinase-2 （MMP- 2）, MMP-9 and tissue inhibitor of metaUoproteinase-2 （TIMP-2） in the occurrence and progression of persistent atrial fibrillation in rheumatic mitral stenosis patients. Methods Thirty-nine patients undergoing mitral valve replacement in the General Hospital of PLA were involved in this study, including 15 patients of rheumatic heart disease （RHD） with sinus rhythm （sinus rhythm group）, 10 RHD with paroxysmal AF （paroxysmal AF group）, and 14 RHD with chronic AF （chronic AF group）. Myocardial samples were obtained from the left auricle during the operation, the degree of atrial fibrosis was observed after Masson staining, and the expression levels of TGF-β1, MMP-2, MMP-9 and TIMP-2 mRNA in the atrial tissue were determined by RT-PCR. Results The collagen volume fraction （CVF） was significantly higher in chronic AF group and paroxysmal AF group than in sinus rhythm group （P〈0.01）, and it was higher in chronic AF group than in paroxysmal AF group （-0〈0.01）. The expression levels of TGF-β1, MMP-2 and MMP- 9 mRNA were significantly higher in chronic AF group and paroxysmal AF group than in sinus rhythm group （P〈0.05,/9〈0.01）, and it was higher in chronic AF group than in paroxysmal AF group （P〈0.05, P〈0.01）. The expression level of TIMP-2 mRNA was significantly lower in chronic AF group and paroxysmal AF group than in sinus rhythm group （P〈0.05, P〈0.01）, and lower in chronic AF group than in paroxysmal AF group （P〈0.05, P〈0.01）. Conclusion TGF-β1, MMP-2, MMP-9 and TIMP-2 may participate in the myocardial fibrosis in rheumatic mitral stenosis patients, and play an important role in the occurrence and progression of atrial fibrillation.

关 键 词：转化生长因子 基质金属蛋白酶类 金属蛋白酶2组织抑制剂 风湿性心脏病 心房颤动 

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