心房颤动患者热休克蛋白47的表达及其与心肌纤维化的相关性研究

The expression of heat shock protein 47 and its correlation to myocardial fibrosis in the atrial tissues inpatients with atrial fibrillation

目的探讨胶原特异性分子伴侣一热休克蛋白47（HSP47）在心房颤动（房颤）的发生和维持中的作用。方法60例行心脏手术的患者分为3组，其中窦性心律组20例，阵发性房颤组20例，持续性房颤组20例，术中获取右心耳心房组织，采用实时荧光定量（FQ-PCR）方法检测HSP47的mRNA表达；同时采用ELISA方法检测上述60例患者血液标本血清中PICP，P11INP的浓度。应用超声心动图测定左心房内径，并研究三者的相互关系。结果①与窦性心律组比较，HSP47mRNA水平在阵发性房颤组，持续性房颤组心房组织中明显增加（P〈0．05，P〈0．05），且持续性房颤组较阵发性房颤组亦明显增加（P〈0．05）。②与窦性心律组相比，房颤患者血清PICP、PIIINP含量明显增高、左心房明显扩大（P〈0．05），且持续性房颤组PICP、PIllNP含量及左心房内径高于阵发性房颤组（P〈0．05）；且血清中心肌纤维化指标PICP、PBINP含量与左心房内径间呈显著的正相关关系。③经相关性分析得出房颤患者心肌组织中HSP47mRNA水平与血清中PICP、P]IINP含量呈独立的正相关；与左心房内径亦呈正相关关系。（r=0．831，P〈0．01；r：0．842，P〈0．01；r=0．780，P〈0．01）。结论①房颤患者存在心肌纤维化及左心房扩大，两者呈正相关关系。提示房颤患者存在左心房结构重构，心肌纤维化在左心房结构重构中起重要作用。②心房组织中HSP47基因表达显著增加，并与房颤的严重程度密切相关，提示可能与房颤的发生和维持有关。③心房组织中HSP47的表达与心肌纤维化指标及左心房内径呈正相关，提示HSP47的表达增加可能是影响心肌纤维化的分子机制之一，与房颤患者心房结构重构密切相关。

To stud the role of the expression of heat shock protein 47 （HSP47） in atrial tissues in atrial fibrillation （AF） generation and maintenance. Methods The fight atrial tissues and bloodserum samples were harvested from 60 patients during cardiac surgery. Of them, 20 patients were in sinus rhythm, 20 patients had persistent AF and 20 patients had paroxysmal AF. The expression of HSP47 mRNA was evaluated by Realtime Fluorescence Quantitative PCR, and the concentrations of carboxyterminal propeptide of type I procollagen （PICP） and amino-terminal propeptide of type procollagen （PIIINP）in serum were measured by enzyme linkedimmunosorbent assay （ELISA）. The left atrial diameters were measured by UCG. Results （1） The HSP47 mRNA level significantly increased both in paroxysmal AF and persistent AF groups compared with the sinus rhythm group（P〈0. 05）. The significant increase in HSP47 was also observed in the persistent AF compared with paroxysmal AF group（P〈0. 05）. （2）Compared with controls, the concentrations of serum PICP, P]UNP and left atrial diameter were significantly increased in patients with AF（ P〈0. 05 ）. The significant increase was also observed in the persistent AF compared with paroxysmal AF groups in the concentrations of serum PICP,PIIINP and left atrial diameter （P〈0.05） . （3） There was a conspicuous and independent direct correlation between the expression of HSP47 and the P ICP, P m NP and left atrial diameter（ r = 0. 831, P〈O. 01 ;r= O. 842, P〈0. 01 ;r=0. 780,P〈0. 01 ）. Conclusions There was a positive correlation between myocardial fibrosis and left atrial enlargementin the patients with atrial fibrillation. The HSP47 gene is highly expressed in right atrial tissues in atrial fibrillation, it indicates that HSP47 gene related with the generationand maintenance of atrial fi brillation. The expression of HSP47 in right atrial tissues was correlated with PICP, PIIINP and left atrial diameter and demonstrated that the increase in expression of HSP47maybe one of the molecule mechanisms of myocardial fibrosis and closely related with structural atrial remodeling.