P53基因与风湿性心脏病心房颤动患者心肌纤维化的相关性研究  

Correlative study between P53 gene and patients with atrial flbrillation in rheumatic heart disease

作　　者：刘茜[1] 魏玲[1] 贾政[1] 王莲[1] 杨静[1] 朱姿英[1] 张丽萍[1] 杨晓华[1] 

机构地区：[1]成都军区昆明总医院地方干部病房,650032

出　　处：《中华临床医师杂志（电子版）》2016年第2期207-213,共7页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨P53基因对风湿性心脏病心房颤动(简称房颤)患者心房结构重构的影响以及可能发生的分子机制。方法 60例风湿性心脏病接受换瓣手术患者分为窦性心律组(SR)和房颤组(AF)。于术中获取右心耳组织、外周抗凝血及非抗凝血。采用实时荧光定量(FQ-PCR)法检测心肌组织中P53、Ⅰ型胶原、Ⅲ型胶原m RNA的表达;ELISA法检测血清中人Ⅰ型前胶原羧基端原肽(PⅠCP)、人Ⅲ型前胶原肽(PⅢNP)的浓度,心肌组织行HE染色病理学检测,并对以上结果进行相关性分析。结果 (1)与SR组比较,AF组左心房内径(LAD)明显扩大;AF组心肌组织中Ⅰ型胶原m RNA水平明显增加(t=2.11,P<0.05);AF组Ⅲ型胶原m RNA表达量无统计学意义(t=0.187,P>0.05);AF组血清PⅠCP、PⅢNP含量明显增加(t=3.491,P<0.01;t=2.695,P<0.05)。(2)病理切片可见SR组心肌间质中仅有少量胶原纤维;AF组可见心肌间质中纤维组织增生,心肌肌束被大量条索状胶原纤维分隔。(3)AF组心肌组织中P53 m RNA水平明显增加(t=4.87,P<0.01);AF组心肌组织中P53 m RNA水平与左心房内径、心肌组织中Ⅰ型胶原m RNA、血清中PⅠCP、PⅢNP呈显著的正相关关系(r=0.776,P<0.01;r=0.765,P<0.01;r=0.798,P<0.01;r=0.615,P<0.05);且Ⅰ型胶原m RNA与PⅠCP成正相关(r=0.698,P<0.05)。结论 P53基因可能是参与房颤患者心房结构重构、心肌纤维化的分子机制之一,可能与房颤的发生和维持有关。Objective To assess the effect of P53 gene influence to atrial fibrillation patients with rheumatic heart disease and the probably mechanisms.Methods 60 cases of rheumatic heart disease patients who accepted valve surgery were divided into sinus rhythm（SR） group and atrial fibrillation（AF）group.We got right atrial appendage tissues,EDTA-blood and None-EDTA-blood in operation.By real-time quantitative（FQ-PCR）,we detected the expression of P53,type Ⅰ collagen,type Ⅲ collagen mRNA in myo-cardial tissue.ELISA was uesed to measure the concentrations of carboxy terminal propeptide of type Ⅰ procollagen（P I CP） and amino-terminal propeptide of type Ⅲ procollagen（PIIINP）in serum.And the myocardial tissue stained with hematoxylin eosin.Moreover,we can perform the correlative factor analysis with those results.Results（1） Compared to SR group,the left atrial diameter（LAD） expanded obviously（P〈0.05）;type Ⅰ collagen mRNA levels were significantly increased in AF group（t=2.11,P〈0.05）,while type Ⅲ collagen mRNA expression increased without correlation（r=0.187,P〈0.05）.Further,the concentration of serum P I CP,PIIINP increased significantly（t=3.491,P〈0.01;t=2.695,P〈0.05）.（2） There was smaller collagen fiber in myocardial stroma in SR group,while myocardial stroma fibrous tissue was remarkable hyperplasia in AF group.（3） The level of P53 mRNA increased significantly in myocardial cells（t=4.87,P〈0.01）.Type Ⅰ collagen in myocardial tissue mRNA and P I CP,PIIINP was significantly positive correlation with LAD（r=0.735,P〈0.01;r=0.798,P〈0.01;r=0.615,P〈0.05）;There was a conspicuous direct positive correlation between the expression of typeⅠ collagen mRNA and PI CP（r=0.698,P〈0.05）.Conclusions The P53 gene may be involved in the mechanism of atrial remodeling and myocardial fibrosis,which closely correlated with structural atrial sustained remodeling.

关 键 词：基因 p53 心房颤动 纤维化 胶原 

分 类 号：R541.2[医药卫生—心血管疾病]