风湿性心脏病二尖瓣狭窄患者血浆肾素血管紧张素醛固酮系统的变化与左心房重构的关系

Relationship between the rennin-angiotensin-aldosterone system and left atrial structure remodeling in patients with rheumatic mitral stenosis

目的研究风湿性心脏病（风心病）二尖瓣狭窄（MS）患者血浆肾素血管紧张素醛固酮系统的变化，并探讨其与左心房重构的关系。方法MS组患者55例，按有无心房颤动分为2组：窦性心律组（SR组）25例，心房颤动组（AF组）30例。正常对照组（NC组）17例。应用放射免疫方法（RIA）测定清晨空腹卧位循环血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）、醛固酮（Ald）水平。结果AF组左心房内径与SR组、NC组相比显著增大，分别增大16．9％[（57．71±8．07）mm和（48．48±5．05）mm，P〈0．01）]与87．8％[（57．71±8．07）mm与（30．18±2．86）mm，P〈0．01]，且SR组与NC组相比左心房内径亦明显增大，增大60．6％[（48．48±5．05）mm与（30．18±2．86）mm，P〈0．01）]。AF、SR组患者循环PRA、AngⅡ、Ald浓度与NC组相比均显著增高（P〈0．01），AF组与SR组相比循环PRA、AngⅡ、Ald浓度亦均明显增高（P〈0．01，P〈0．05）。应用Pearson相关分析显示MS患者左心房内径大小与循环PRA．AngⅡ、Ald浓度呈正相关系（r分别为0．277、0．485、0．431，P值分别为〈0．05，〈0．01，〈0．01），、经多元线性逐步回归分析表明：循环AngⅡ和Ald与左心房内径呈直线相关（Bate值分别为0．362、0．261，P〈0．01、P〈0．05）。结论MS患者存在循环肾素血管紧张素醛固酮系统（RAAS）的激活，循环AngⅡ和Ald可能与左心房重构有关。

Objective To determine the relationship between the rennin-angiotensin-aldosterone systems （RAAS） and left atrial structure remodeling in patients with rheumatic mitral stenosis. Methods The patients with rheumatic mitral stenosis were divided into two groups according to atrial fibrillation ： sinus rhythm group （ SR group, n = 25） and atrial fibrillation group （AF group, n = 30）. 17 normal subjects were selected as normal control group （NC）. The plasma concentration of renin, angiotonin II （Ang II） and aldosterone（Ald） were measured by radioimmunoassay （ RIA）. Results The average value of the left atrial diameter in AF group was significantly greater than that of both SR group and NC group,increased by 16.9% [ （ 57.71 ± 8.07 ） mm vs. （48.48 ± 5.05 ） mm, P 〈 0. 01 ） ]and 87.8 % （57.71 ± 8.07 mm vs. 30.18 ±2.85 mm,P 〈0.01 ） respectively. Compared with NC group,the left atrial diameter of SR group was also significantly greater, elevated by 60.6 % [ （ 48.48 ± 5.05 ） mm vs. （ 30.18 ± 2.85 ） mm,P 〈 0.01 ） ]. The level of plasma rennin activity （ PRA ） , Ang II and Aid in AE and SR patients was significantly higher than those of NC subjects （ P 〈 0.01 ） , and compared with SR patients, the level of those in AF patients was also significantly increased（ P 〈 0.01 ,P 〈 0.05）. Pearson correlation analysis revealed a positive correlation between the plasma level of PRA ,Ang Ⅱ or Aid and the value of the left atrial diameter（ r = 0.277,0.485,0. 431 ,P 〈 0.05 ,P 〈 0.01 ,P 〈 0.01 ）. Multiple liner stepwise regression analysis showed thatplasma Ang Ⅱ and Aid were the important risk factors that affected left atrial diameter in patients with rheumatic mitral stenosis （ Bate = 0. 362,0. 261, P 〈 0.01, P 〈 0.05 ）. Conclusion Patients with rheumatic mitral stenosis are characterized by the activation of circulating RAAS. and the plasma Ang Ⅱ and Aid may contribute to left atrial structure remodeling.