辅助性T淋巴细胞失衡在各类非术后心房颤动中的作用

Role of imbalance of helper T-lymphocyte in different types of non-postoperative patients with atrial fibrillation

目的:探讨非术后心房颤动(房颤)患者外周血中辅助性T淋巴细胞(Th)失衡在不同阶段中的作用。方法:选择房性心律失常患者65例,其中非房颤性房性心律失常(包括房性心动过速、心房扑动、阵发性室性心动过速)22例(AA组)、阵发性房颤21例(Paro-Af组)、持续性房颤22例(Per-Af组);另取性别、年龄、基础疾病相匹配的窦性心律者15名作为对照组。ELISA法检测血清中的干扰素(IFN)-γ、白细胞介素(IL)-4浓度。结果:对照组、AA组、Paro-Af组、Per-Af组血清中IFN-γ水平、IFN-γ/IL-4比值依次升高,而IL-4水平依次降低。对照组、AA组、Paro-Af组的IFN-γ水平、IFN-γ/IL-4比值和IL-4水平均差异无统计学意义,而Per-Af组的IFN-γ水平和IFN-γ/IL-4比值与其他3组比较均差异有统计学意义(均P<0.05)。同时,左房直径与IFN-γ/IL-4比值呈正相关(r=0.752,P<0.01),直线回归方程Y=0.473X+3.267。结论:房颤的病理过程中存在Th的失衡现象,主要见于持续性房颤;Th失衡造成的免疫损伤可能为持续性房颤的发病机制之一。由IFN-γ/IL-4比值与左房直径的关系,推测左房直径大小的改变为正常心肌细胞免疫损伤的结果。

Objective：To investigate the role of imbalance of helper T-lymphocyte in patients with different stages of atrial fibrillation.Method：The peripheral blood samples were collected from 80 subjects,which divided into 15 normal control subjects（control group）,22 non fibrillatory atrial arrhythmias（AA group） including atrial tachycardia,paroxysmal supraventricular tachycardia and atrial flutter,21 paroxysmal atrial fibrillation（Paro-Af group）,22 persistent atrial fibrillation（Per-Af group）.The serum levels of IFN-γ and IL-4 were measured by ELISA method.Result：The serum level of IFN-γ and the ratio of IFN-γ/IL-4 were significantly higher in all groups.However,the levels of IL-4 were decreased in all groups.There was no significant difference in IFN-γ,IL-4 and the ratio of IFN-γ/IL-4 among control,Paro-Af and AA groups.The level of IFN-γ and the ratio of IFN-γ/IL-4 were significantly higher in Per-Af group compared with those in the other three groups.There was also a positive correlation between IFN-γ/IL-4 ratio and the left artial dimension（r=0.752,P0.01）,and the linear regression equation was Y=0.473X＋3.267.Conclusion：Imbalance of helper T-lymphocyte contributes to the pathogenesis of atrial fibrillation and mainly occurs in persistence atrial fibrillation.The immune inflammation is the main cause of pathological changes in persistent atrial fibrillation.The positive correlation between left atrial size and IFN-γ/IL-4 ratio may suggest that the immune injury of normal cardiac myocytes results in the changes of left atrial size.