瓣膜性心房颤动患者心房结构重塑特征分析的多中心研究  

Features of atrial structure in patients with valvular atrial fibrillation:a multicenter study

作　　者：潘军强[1] 张殿新[2] 寿锡凌[1] 周鑫[3] 孙超峰[3] 

机构地区：[1]陕西省人民医院心内二科,陕西西安710068 [2]第四军医大学附属西京医院心血管内科,陕西西安710032 [3]西安交通大学第一附属医院心血管内科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2016年第1期74-77,107,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.81270236)~~

摘　　要：目的 在人体组织学水平观察瓣膜性心房颤动患者心房结构重塑的特点。方法 选取西安交通大学医学部第一附属医院、西京医院、陕西省人民医院心脏外科因风湿性心脏瓣膜病住院并行瓣膜置换手术的患者84例,其中心房颤动组39例,窦性心律组45例。收集整理患者的临床资料,并于手术中获取右心房组织（0.3~0.5mm3）。HE染色、Masson染色观察两组患者右心房纤维化程度;RT-qPCR技术测定心房组织中Ⅰ、Ⅲ型胶原mRNA的表达。结果 两组患者在性别构成比、年龄、血压、血常规、生化指标等方面经统计学分析,差异无统计学意义（P〉0.05）;心房颤动组左、右心房直径明显大于窦性心律组（P〈0.05）;HE染色、Masson染色结果提示心房颤动组心房组织存在明显纤维化,心房颤动组胶原容积分数显著高于窦性心律组（45.37±2.33 vs.12.90±1.02,P〈0.05）;心房颤动患者心房组织中Ⅰ型胶原mRNA表达明显高于窦性心律组（2.042±0.177 vs.0.988±0.099,P〈0.05）,而Ⅲ型胶原mRNA的表达较窦性心律组高,但组间比较差异无统计学意义（1.228±0.151 vs.1.067±0.068,P〉0.05）。结论瓣膜性心房颤动患者心房组织存在明显的心房纤维化,与Ⅰ型胶原基因转录水平上调密切相关。Objective To study the features of atrial structure in patients with valvular atrial fibrillation at the human histological level. Methods For this study, we enrolled 84 patients with rheumatic heart disease who were going to receive cardiac surgery at the First Affiliated Hospital of Xi＇an Jiaotong University, Xijing Hospital, and Shaanxi Provincial People＇s Hospital. The patients were divided into the atrial fibrillation group （AF, n = 39） and the sinus rhythm group （SR, n=45）. Clinical data including baseline demographics, routine laboratory test results and echocardiographics were available for all patients before the surgery. The right atrial tissue （0.3--0.5 mm3） was dissected during the surgery. Right atrial fibrosis was observed by HE staining and Masson staining, mRNAs of type Ⅰ , Ⅲ collagen in atrial tissue were determined by real-time quantitative PCR. Results The two groups did not differ significantly in sex ratio, age, blood pressure, blood biochemical indicators or other aspects of medical history between （P〉0.05）. However, left and right atrium diameters were significantly larger in the AF group than in the SR group （P〈0. 05）. HE and Masson staining results suggested that atrial tissue fibrosis was obvious, and collagen volume fraction was significantly higher in the AF group than in the SR group （45.37±2.33 vs. 12.90±1.02, P〈 0.05）. Expression of type I collagen mRNA was significantly higher in the AF group than in the SR group （2. 042± 0. 177 vs. 0. 988±0. 099, P〈0.05）; expression of type Ⅲ collagen mRNA was higher in the AF group than in the SR group, but without significant difference （1.228±0.151 vs. 1.067±0.068, P〉0.05）. Conclusion There is significant atrial fibrosis in patients with valvular atrial fibrillation; which is closely related to up-regulated expression of type I collagen gene.

关 键 词：风湿性心脏瓣膜病 心房颤动 心房纤维化 心房重塑 胶原蛋白 

分 类 号：R541.7[医药卫生—心血管疾病]