OPG/RANK/RANKL轴与二尖瓣合并房颤患者术后窦性心律稳定性的相关性研究

OPG/RANK/RANKL axis in stabilization of spontaneously restored sinus rhythm in permanent atrial fibrillation patients after mitral valve surgery

目的:探讨OPG/RANK/RANKL轴与二尖瓣合并永久性房颤患者术后自动转复的窦性心律稳定性的关系及其临床意义。方法:选取135例在行单纯二尖瓣置换术后自动复律的房颤患者,根据术后7 d内房颤是否复发分为房颤(AF)组和窦性心律(SR)组。术中取右心耳组织,采用Western blot及免疫组织化学法检测组织中OPG、RANK、RANKL的表达,用Masson三色法检测组织中间质纤维化程度。结果:AF组RANK和RANKL表达水平以及RANKL/OPG比值均高于SR组,胶原容积分数(CVF)在SR组显著低于AF组,RANK、RANKL表达水平以及RANKL/OPG比值与CVF呈显著正相关。结论 :OPG/RANK/RANKL轴可能参与了二尖瓣合并房颤患者术后房颤的复发,因此可作为房颤上游治疗一新靶点。

Objective：To investigate the expression of osteoprotegerin （OPG）/receptor activator of nuclear factor-KB （RANK）/ RANK ligand（RANKL） axis in stabilization of spontaneously restored sinus rhythm in permanent atrial fibrillation patients after mitral valve （MV） surgery and study its clinical significance. Methods： Clinical data, biopsies of right atrial appendage were collected from 135 atrial fibrillation patients who spontaneously restored sinus rhythm after conventional isolated MV replacement. Comparison was made between patients who had recurrence of atrial fibrillation within 7 days （AF group） vs. patients with persisted sinus rhythm for more than 7 days （SR group）. Results：The result of Western blot and immunohistochemistry showed an increased expression of RANK,RANKL and RANKL/OPG ratio in AF group than SR group. The degree of interstitial fibrosis reflected by collagen volume fraction （CVF） was also more severe in AF group than SR group,which was positively correlated with the expressions of RANK and RANKL and RANKL/OPG ratio. Conclusion：These findings suggest that the OPG/RANK/RANKL axis plays important roles in stabilization of restored sinus rhythm after MV surgery by stimulating AF-related atrial remodeling in atrial fibrillation patients,and possibly represents a new target for upstream treatment of atrial fibrillation.