缺血心肌病心肌纤维化指标的变化及其机制

Changes of myocardial fibrotic indices and its mechanism in patients with ischemic cardiomyopathy

目的:观察缺血心肌病(ICM)患者心肌纤维化指标的改变,探讨心肌纤维化机制。方法:采用放射免疫方法测定46例ICM和37例正常对照组血清中Ⅲ型前胶原末端肽(PⅢP)、Ⅳ型前胶原末端肽(PⅣP)、层粘连蛋白(LN)、透明质酸(HA)、及血浆血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)及转化生长因子β1(TGFβ1)含量。将AngⅡ,ALD,及TGFβ1水平分别与PⅢP,PⅣP,LN及HA水平进行相关分析。结果:ICM患者血清PⅢP,PⅣP,LN及HA水平和血浆AngⅡ,ALD及TGFβ1浓度明显增高,AngⅡ和ALD与血清PⅢP,PⅣP,LN及HA密切相关,TGFβ1与PⅢP和PⅣP相关。结论:ICM存在不同程度的心肌纤维化,血清中PⅢP,PⅣP,LN及HA含量可间接反应心肌纤维化程度。AngⅡ,ALD及TGFβ1水平在纤维化过程中起着重要作用。

Objective To investigate the myocardial fibrotic indices in patients with ischemic cardiomyopathy （ICM） , and explore the mechanism of myocardial fibrosis. Methods The concentration of serum procollagen type Ⅲ aminoterminal peptide （PⅢP）, procollagen type Ⅳ aminoterminal peptide （PⅣP）, lamnin （LN）, and hyaluronic acid （HA）, as well as plasma angiotension Ⅱ （AngⅡ）, aldo- sterone （ALD）,and transforming growth factor beta 1 （TGFβ1） in 46 ICM patients and 37 normal controls were measured by radioimmunoassay （RIA）. The correlations between the plasma levels of AngⅡ, ADL, TGFβ1 , and serum levels of ProP, PⅣP, LN, and HA were analyzed. Results Compared with normal controls, the concentrations of serum PⅢP, PⅣP, LN, HA, and plasma AngⅡ, ADL, and TGEβ1 significantly increased in ICM patients. AngⅡ, ALD, and TGFβ1 levels were positively correlated with the indices of myocardial fibrosis. Conclusion The myocardial fibrosis exists in ICM patients and the serum concerntrations of PⅢP,PⅣP, LN, and HA may be an indirect index of myocardial fibrosis. AngⅡ, ADL, and TGFβ1 levels play important roles in myocardial fibrosis.