Toll样受体2、基质金属蛋白酶9、低氧诱导因子1α与心房颤动发生和维持的关系

Relationship of Toll-like receptor 2,hypoxia induced factor-1α,matrix metalloproteinase-9 with occurrence and maintenance of atrial fibrillation

目的探讨Toll样受体2(TLR2)、基质金属蛋白酶9(MMP-9)、低氧诱导因子1α(HIF-1α)作为免疫炎症因子与心房颤动(房颤)发生和维持的关系。方法入选125例房颤患者,其中阵发性房颤34例,持续性房颤49例,永久性房颤42例,选择窦性心律者38例作为对照组。比较各组患者血清中TLR2、MMP-9、HIF-1α的表达水平,同时测量左心房内径及射血分数。结果 TLR2表达水平在永久房颤组和持续房颤组明显高于对照组847.3(1 047.7)ng/L、757.2(1 032.5)ng/L vs 744.8(652.3)ng/L(P<0.05);永久房颤组TLR2高于阵发房颤组847.3(1 047.7)ng/L vs 796.6(849.1)ng/L(P<0.05)。MMP-9表达水平在永久房颤组明显高于对照组447.1(491.9)ng/L vs 308.9(200.7)ng/L(P<0.05);永久性房颤组和持续房颤组MMP-9高于阵发房颤组447.1(491.9)ng/L、307.7(678.0)ng/L vs 264.2(303.3)ng/L(P<0.05)。HIF-1α表达水平在永久房颤组和持续房颤组高于对照组57.2(48.8)ng/L、61.4(46.3)ng/L vs 46.7(29.6)ng/L(P<0.05);永久性房颤组和持续房颤组HIF-1α高于阵发房颤组57.2(48.8)ng/L、61.4(46.3)ng/L vs 52.5(42.8)ng/L(P<0.05)。永久房颤组和持续房颤组左心房内径较对照组和阵发性房颤组增加(45.70±6.71)mm、(42.67±6.83)mm vs(38.55±4.51)mm、(40.82±5.45)mm(P<0.05)。而持续房颤组左心室射血分数较对照组和阵发性房颤组明显降低(49.47±7.14)%vs(54.89±6.25)%、(53.90±8.02)%(P<0.05);永久性房颤组左心室射血分数较持续性房颤组明显降低(45.60±8.02)%vs(49.47±7.14)%(P<0.05)。结论 TLR2、HIF-1α、MMP-9作为免疫炎症因子水平的升高可能与房颤的发生及维持有关,提示炎症参与了房颤的发生与维持。

Objective To discuss the relation of Toll-like receptor 2（TLR2）,hypoxia induced factor-1α（HIF-1α）,matrix metalloproteinase-9（MMP-9） as immunological and inflammatory factors with occurrence and maintenance of atrial fibrillation. Methods 125 cases of atrial fibrillation were chosen,34 cases were paroxysmal atrial fibrillation and 49 cases were persistent atrial fibrillation and 42 cases were permanent atrial fibrillation,38 sinus rhythm cases were also selected into the control group.TLR2,HIF-1α,MMP-9 levels of each group were compared and left atrial diameter and left ventricular ejection fraction（LVEF） were measured,respectively. Results TLR2 levels of permanent and persistent atrial fibrillation group were significantly higher than that of the control group 847.3（1 047.7） ng/L,757.2（1 032.5） ng/L vs 744.8（652.3） ng/L（P0.05）,TLR2 level of permanent atrial fibrillation group was significantly higher than that of the paroxysmal atrial fibrillation group 847.3（1 047.7） ng/L vs 796.6（849.1） ng/L（P0.05）.MMP-9 level of permanent atrial fibrillation group was significantly higher than that of control group,447.1（491.9） ng/L vs 308.9（200.7） ng/L（P0.05）,MMP-9 levels of permanent and persistent atrial fibrillation group were significantly higher than that of paroxysmal atrial fibrillation447.1（491.9） ng/L,307.7（678.0） ng/L vs 264.2（303.3） ng/L（P0.05）.HIF-1α levels of permanent and persistent atrial fibrillation group were significantly higher than that of control group57.2（48.8） ng/L,61.4（46.3） ng/L vs 46.7（29.6） ng/L（P0.05）,HIF-1α levels of permanent and persistent atrial fibrillation group were significantly higher than that of paroxysmal atrial fibrillation57.2（48.8） ng/L,61.4（46.3） ng/L vs 52.5（42.8） ng/L（P0.05）.Compared with that of paroxysmal atrial fibrillation group and control group,left atrial diameter of the permanent and persistent atrial fibrillation group increased significantly（45.70±6.71） mm,（42.67±6.83） mm vs（38.55±4.51） mm,（40.82±5.45） mm（P0.01）.However,compared with that of paroxysmal atrial fibrillation group and control group,LVEF of permanent and persistent atrial fibrillation group decreased significantly（49.47±7.14）% vs（54.89±6.25）%,（53.90±8.02）%（P0.01）.Compared with that of persistent atrial fibrillation group,LVEF of the permanent atrial fibrillation group decreased significantly（45.60±8.02）% vs（49.47±7.14）%（P0.01）. Conclusion The increases of TLR2,HIF-1α,MMP-9 level probably participate in occurrence of atrial fibrillation,thus indicating that the inflammatory reaction may promote the occurrence and maintenance of atrial fibrillation.