房颤不同时期结构重构的血清学变化

The Serologic Changes of Structural Remodeling During Different Periods of Atrial Fibrillation

目的:探讨转化生长因子-β1(TGF-β1)、基质金属蛋白酶-9(MMP-9)、金属蛋白酶组织抑制因子-1(TIMP-1)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-10(IL-10)与阵发性或持续性房颤结构重构的关系。方法:入选患者分为3组,其中持续性房颤组30例、阵发性房颤组45例,以及32例阵发性室上速(包括预激综合征)作为对照组,通过ELISA方法检测上述患者左房血清的TGF-β1、MMP-9、TIMP-1、TNF-α、IL-6、IL-10水平,超声测量左心房长径。分析上述细胞因子水平与阵发性房颤或持续性房颤的关系。结果:阵发性房颤组与对照组相比,左房内径增大、TGF-β1、TNF-α升高(P<0.05),IL-10、TIMP-1降低(P<0.05),MMP-9无统计学差异。持续性房颤组与对照组相比,TGF-β1无统计学差异(P>0.05),MMP-9、TNF-α、IL-6均升高(P<0.05),IL-10、TIMP-1降低(P<0.05);阵发性房颤组TGF-β1高于持续性房颤组(P<0.05),持续性房颤组左房内径及MMP-9高于阵发性房颤组(P<0.05)。结论:阵发性房颤患者左房扩大,已出现结构重构,结构重构的血清学变化以TGF-β1升高为主;持续性房颤患者结构重构血清学变化以MMP-9、IL-6升高为主。

Objective： To investigate the relationship of TGF-β1, MMP-9, TIMP-1, TNF-α, IL-6, IL-10 with paroxysmal atrial fibrillation（AF） or persistent AF. Methods： The patients was divided into three groups, including 45 paroxysmal AF patients, 30 persistent AF patients and a control group of 32 paroxysmal suprawentricular tachycardia or WPW patients who underwent catheter ablation, Serum samples were respectively taken from left atrium of these patients and, the pre-ablation plasma concentrations of TGF-β1, MMP-9,TIMP-1, TNF-α, IL-6, IL-10 were evaluated by ELISA. The left atrial diameter（LAD） was detected by echocardiography. Results：Paroxysmal AF group compared with control group, the level of LAD, TGF-β1, TNF-α was increased（P〈0.05）, the level of IL- 10 and TIMP- 1 was lower（P〈0.05）, and MMP- 9 had no statistical difference（P〈0.05）. Persistent AF group compared with control group, the level of TGF-β1 had no statistical difference（P〈0.05）, the level of MMP- 9, TNF-α, IL- 6 was higher（P〈0.05）, and IL- 10 and TIMP-1 was lower（P〈0.05）. Comparison between paroxysmal AF group and persistent AF group, the levels of TGF-β1 in paroxysmal AF group was higher, LAD and the level of MMP- 9 was lower than that of persistent AF group（P〈0.05）. Conclusions： Patients with paroxysmal AF already have structural remodeling, left atrial dilated, and the serum changes of structural remodeling are given priority to elevated TGF-β1, while the serum changes of structural remodeling in persistent AF are given priority to elevated MMP- 9 and IL- 6.