房颤射频消融术后单个核细胞动员与MMP-9升高相关  

The Mobilization of Mononuclear Cells in Patients with Atrial Fibrillation after Radiofrequency Ablation was Associated with Elevated MMP-9

作　　者：沈运丽[1] 钱菊英[2] 葛均波[2] 陈义汉[1] 

机构地区：[1]同济大学附属东方医院心内科,上海市200120 [2]复旦大学附属中山医院心内科上海市心血管病研究所,上海市200032

出　　处：《中国分子心脏病学杂志》2016年第4期1761-1765,共5页Molecular Cardiology of China

基　　金：上海市自然科学基金(15ZR1434100);国家自然科学基金(81500201)

摘　　要：目的探讨房颤患者射频消融术后有无单个核细胞动员及机制。方法连续收集实施射频消融的持续性房颤和阵发性房颤患者共25例,采集射频消融术前及术后第1天外周血,使用流式细胞仪检测CD117^+单个核细胞、CXCR4^+单个核细胞、CD34^+CD133^+单个核细胞比例,采用酶联免疫法(ELISA)检测基质金属蛋白酶-9(MMP-9)、人生长调节致癌基因β/黑素瘤生长刺激因子(GR0β)、基质细胞衍生因子1(SDF-1)、白细胞介素6(IL-6)、白细胞介素8(IL-8)、粒细胞集落刺激因子(G-CSF)、血管生成素1(ANG1)、cTnT及CK-MB等。结果房颤患者射频消融术后cTnT明显增高(P<0.001),提示射频消融导致了非缺血性心肌损伤,而且术后MMP-9(P=0.001),GR0β(P=0.014)、G-CSF(P=0.04)和IL-6(P=0.011)等细胞因子均显著升高,但SDF-1较术前明显减少,IL-8无明显变化。房颤患者射频消融术后外周血CXCR4+单个核细胞(20.45%±12.32%vs 37.75%±17.00%,P<0.001)及CD34^+CD133^+单个核细胞(7.04%±4.91%vs 11.80%±4.26%,P=0.001)显著动员,但CD117+单个核细胞无明显变化(P>0.05)。房颤患者射频消融术后cTnT与MMP-9呈正相关(R=0.636,P=0.001),而且消融术后cTnT和MMP-9均与CXCR4^+单个核细胞比例(R=0.674,P<0.001;R=0.579,P=0.002)及CD34^+CD133^+单个核细胞比例(R=0.655,P<0.001;R=0.522,P=0.007)呈正相关,但与CD117^+单个核细胞比例无关(P均>0.05)。结论房颤患者射频消融术导致了非缺血性心肌损伤,进而发生CXCR4^+单个核细胞及CD34^+CD133^+单个核细胞动员,两者动员程度与心肌损伤程度呈正相关,其动员机制不依赖SDF-1α/CXCR4轴,而与MMP-9升高呈正相关,提示缺血性心肌损伤和非缺血性心肌损伤后外周单个核细胞的主要动员机制不同。Objective To investigate mononuclear cells mobilization mediated by non-ischaemic titrated myocardial injury after radiofrequency catheter ablation （RFCA） in patients with atrial fibrillation （AF）. Methods Blood samples were collected in 25 in-patients with AF on admission and the day after RFCA. Matrix metalloproteinasc （MMP）-9, human growth regulator oncogene β / melanoma growth- stimulating factor （GROβ）, stromal cell-derived factor （SDF）-I, interleukin （IL）-6, IL-8, granulocyte colony- stimulating factor （G-CSF）, angiotensin（ANG）l, cardiac troponin T （cTnT） and creatine kinase-MB （CK-MB） were measured by ELISA. CDl17＋, CXCR4＋ and CD133＋CD34＋ mononuclear cells were analyzed by fiow cytometry. Results The percent increase in CXCR4＋（20.45% ± 12.32% vs 37.75% ± 17.00%, P 〈 0.001）and CD34＋CD133＋cells （7.04%±4.91% vs 11.80%± 4.26%,P=0.001） were significant after RFCA compared with before RFCA, and correlated with cTnT （ R=0.674, P〈0.001; R=0.579, P=0.002） and MMP-9, R=0.655, P〈0.001; R=0.522, P=0.007, respectively. A rise in CK-MB and cTnT levels indicated myocardial necrosis in AF patients undergoing RFCA（ 12.76 ± 4.12u/l vs 21.96 ± 6.19 u/l,P〈0.001; 0.0034 ± 0.0031 rig/ml vs 1.6172 ±1.0049 ng/ml, F〈0.001）. MMP-9 （50.69 ±24.60 ng/ml vs 103.40 ±72.25 ng/ ml, P=0.001）, GR013 （35.70 ± 19.68pg/ml vs 50.21 ± 20.41pg/ml, P=0,014）, G-CSF （39.05 ± 18.76 pg/ml vs 50.25 ± 18.75 pg/ml, P=-0.04） and IL-6 （73.07 ± 32.88 pg/ml vs 95.95 ± 27.88 pg/ml, P=0.011） levels increased significantly after the procedure. In contrast, SDF-1 andANG1 levels decreased significantly after RFCA（753.31±194.35 pg/ml vs 616.29±160.97 pg/ml, P=0,009; 10.408 ± 4.548ng/ml vs 8.185 ±2.737, P=0.042）.Yet, no significant changes were observed in the proportion of circulating CD 117＋ mononuclear cells. Conclusions Non-ischaemic titrated myocardial injury caused by RFCA in patients with AF mobilizes CXCR4＋ and CD34＋CD133＋cdls t

关 键 词：房颤 射频消融 单个核细胞 动员 MMP-9 

分 类 号：R541.75[医药卫生—心血管疾病]