甲状腺功能亢进性心脏病患者左心扩大与血管紧张素Ⅱ1型受体自身抗体的关系

Relationship between angiotensin Ⅱ type 1 receptor agonistic autoantibody and cardiac remodeling in patients with hyperthyroid heart disease

目的 探讨甲状腺功能亢进性心脏病（甲亢性心脏病）患者左心扩大与血管紧张素Ⅱ1型受体自身抗体（AT1-AA）的关系.方法 应用酶联免疫吸附法（ELISA）,以细胞外第二环表位肽段的合成肽作为抗原,检测58例甲亢性心脏病患者血清AT1-AA,并观察超声心动图变化.根据检测结果将甲亢性心脏病患者分为AT1-AA阳性组和AT1-AA阴性组,比较两组患者超声心动图的差异,采用多元Logistic回归分析影响甲亢性心脏病患者左心扩大的因素.结果 （1）58例甲亢性心脏病患者AT1-AA阳性率为46.4%.（2）AT1-AA阳性组左心房及左心室内径分别为（36.93±4.47）mm和（54.59±4.14）mm,明显大于阴性组的（33.48±2.77）mm和（51.77±3.11）mm（P均〈0.05）;而且AT1-AA阳性组左心房和左心室扩大比率（分别为63.0%和51.9%）明显高于阴性组（分别为35.5%和22.6%,P均〈0.05）.（3）多元Logistic回归分析显示,血清AT1-AA阳性和甲亢病程是左心房及左心室扩大的危险因素.结论 AT1-AA与甲亢性心脏病患者左心扩大有关.

Objective To investigate the relationship between agonistic autoantibody against an- giotensin il type 1 receptor（AT±AA） and left cardiac enlargement in patients with hyperthyroid heart disease（HHD）. Methods The epitopes of the second extracellular loop of AT1 R（ 165-191 ） was synthe- sized and used to screen autoantibodies from 58 participants by enzyme linked immunosorbent assay （ELISA）. Echocardiography was also performed in patients with HHD. The difference of echocardiography parameters were compared between the AT±-AA positive group and negative group. Factors related to left heart enlargement were analyzed by multiple logistic regression. Results （ 1 ） The positive rate of AT1 -AA was 46.4% （27/58）. （2）Left atrial and ventricular diameters in AT1-AA positive group were （36.93 ＋ 4.47 ） mm and （54.59 ± 4.14） mm respectively, significantly higher than those in negative group [ （33.48 ± 2.77） tmn and （51.77 ± 3.11 ） mm, all P 〈 0.05）. The ratios of left atrial and ventricular enlargement in positive group were also significantly higher than those in negative group（63.0% vs 35.5% ,51.9% vs 22.6% ,all P 〈 0. 05 ）. （3） Regression analysis demonstrated that AT1 -AA and course of hyperthyroidism were related to left atrial and ventricular enlargement. Conclusion AT1-AA is involved in left cardiac dila- tation of patients with HHD.