MMP-9/TIMP-1在风心病射频消融术后房颤复发中的表达及意义  

Impact of MMP-9/TIMP-1 on Atrial Fibrillation Recurrence after Radiofrequency Modified Maze Procedure in Patients with Rheumatic Valve Disease

作　　者：李源[1] 王欣[1] 柳磊[1] 刘玉学[1] 王巍[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外医院心外科,100037

出　　处：《中国分子心脏病学杂志》2015年第2期1256-1259,共4页Molecular Cardiology of China

摘　　要：目的改良迷宫术是外科治疗房颤的有效方法,但对于瓣膜病特别是风湿性心脏病所合并房颤的患者,早期的手术效果并不理想。本研究目的是观察基质金属蛋白酶-9(MMP-9)和金属蛋白酶组织抑制剂1(TIMP-1)在风心病患者房颤射频消融术后左房组织中的表达,探讨其与疗效的相关性。方法从80例行瓣膜置换同期行射频消融的风心病合并持续性房颤患者中获取组织标本。根据随访术后6个月心律的情况,结果分为房颤未消除组(24例)及窦性心律组(56例)。应用半定量逆转录-聚合酶连反应技术(RT-PCR)及免疫印迹方法 (Western blotting)检测心房组织中基质金属蛋白酶9的m RNA及蛋白的表达水平。结果与窦性心律组相比,房颤组MMP-9的m RNA、蛋白的表达及胶原容量分数(Collagen Volume Fraction,CVF)显著增高。(P=0.001;P=0.01;P=0.003),同时TIMP-1的m RNA及蛋白的表达两组无显著差别。关联分析显示心房组织中MMP-9的m RNA及蛋白的表达及CVF(r=0.625,P<0.01 VS r=0.567,P<0.01)与左房的直径成正相关。结论 MMP-9与左心耳的胶原容量分数(CVF)成正相关,与在风心病射频消融术后房颤复发有相关性。Objective Radiofrequeucy modified maze procedure is considered as an effective surgical treatment of atrial fibrillation （AF）. However, the early surgical results for AF associated with valve disease, especially rheumatic valve disease, had been reported to be less effective. Recently, the upregulation of matrix metalloproteinase （MMP）-9 in atrium had been shown to be associated with the development of atrial fibrillation. Therefore, we aimed to elucidate whether MMP-9 and its specific tissue inhibitor （TIMP）-I were associated with the effectiveness of radiofrequency modified maze procedure in AF patients with rheumatic valve disease. Methods Tissue samples were obtained from 80 patients with persistent AF and rheumatic mitral valve disease who underwent valvular replacement operation and concomitant radiofrequency modified maze procedure. Based on the cardiac rhythm 6 months after operation, the subjects were divided into the AF recurred group（n=24） and the sinus rhythm （SR） maintained group（n=56）. The mRNA and protein expression of MMP-9 and （TIMP）-I in atrium were determined by RT-PCR and Western blotting. Picrosirius red was used to stain collagen in atrium. Results The mRNA and protein expression of MMP-9 and collagen volume fraction （CVF） in the AF recurred group were increased significantly than in the SR maintained group （P=0.001; P=0.001; P=0.003 respectively）. While the mRNA and protein expression of TIMP-1 did not show any difference between the two groups. The mRNA and protein expression of MMP-9 in atrium were positively correlated with CVF （r=0.625, P 〈 0.001 and r=0.567, P 〈 0.001, respectively） and left atrial dimension （r=0.424, P=0.002 and r=0.651, P 〈 0.002, respectively）, Conclusions Our findings clearly indicated that the expression of MMP-9 was positively correlated with the CVF in left atrial appendage and contributes to the AF recurrence after radiofrequeney modified maze procedure in patients with rheumatic valve disease.

关 键 词：心房颤动 基质金属蛋白酶9 金属蛋白酶组织抑制剂1 

分 类 号：R654.2[医药卫生—外科学]