风湿性心脏瓣膜病心房颤动患者心房结构重构及胶原的表达

Atrial structure remodeling and expression of collagen in atrial tissue in patients with rheumatic heart disease and atrial fibrillation

目的检测风湿性心脏瓣膜病心房颤动患者心房结构重构及胶原的表达,探讨胶原在心房结构重构中的意义。方法选择行开胸心脏手术的风湿性心脏瓣膜病患者39例,将持续性心房颤动患者24例为房颤组,窦性心律患者15例为窦律组。取患者心房组织标本,应用HE染色及Masson染色进行组织学检查;免疫组织化学法检测心房组织中Ⅰ型、Ⅲ型胶原蛋白的表达。结果房颤组患者较窦律组左心房内径明显增大。房颤组患者心房有肌溶解、心肌肥厚及广泛间质纤维化的改变。与窦律组比较,房颤组患者的左、右心房组织胶原容积分数均明显增大,左、右心房Ⅰ型胶原蛋白的表达明显增加(P<0.05),而Ⅲ型胶原蛋白表达无明显差异(P>0.05)。结论心房颤动患者心房结构发生明显的病理改变,其中心房间质纤维化为主要特征,左心房改变最为明显。

Objective To examine the change of structural remodeling and expression of collagen in atrial tissue in patients with rheumatic heart disease and atrial fibrillation. Methods Atrial tissue samples were obtained from 39 patients with mitral valve disease and rheumatic heart disease dur- ing open heart surgery. Of these patients, 24 had atrial fibrillation（AF group） and 15 had sinus rhythm（SR group）. For each sample,histological examination was performed with routine hema- toxylin/eosin and Masson staining. Histological assessment software was used to calculate extra- cellular collagen volume fraction（CVF） and quantify the amount of extracellular collagen matrix. Furthermore,type I and Ⅲ collagen protein levels were measured by immunohistochemical tech- niques. Results Compared with SR group,left atrial inner diameter was significantly increased in the patients of the AF group. In the histological examination,myocardial hypertrophy,severe my olysis and extensive fibrosis in the interstitial space of the atria were found in AF group, Masson stain showed that extraeellular CVF was also significantly increased in either RA or LA of AF group （P 〈 0.05）. The type- I collagen protein levels in the LA and RA significantly increased in patients of AF group compared with those of SR group （P〈 0.05） ,whereas type-Ⅲ collagen pro- tein was not significantly different between the two groups. Conclusion Atrial fibrillation results in significant pathological alterations in atrial structure,extracellular matrix and myocytes. Atrial structural remodeling in the artium of patient with AF is characterized by extensive atrial intersti- tial fibrosis,especially in LA.