风湿性心瓣膜病心房颤动患者心房组织纤维化重构与TGF-β_1表达的相关性研究

Study on the correlation between atrial fibrosis remodeling and TGF-β_1 expression in patients with rheumatic heart

目的探讨风湿性心脏病(风心病)心房颤动(房颤)患者心房组织纤维化重构及其可能机制。方法收集四川省宜宾市第二人民医院2013年10月至2015年10月风湿性心瓣膜病行二尖瓣置换术或先天性心脏病开胸修补术患者的临床资料和右心房组织标本,分为窦性心律组(RHD-SR组)、阵发性房颤组(RHD-pAF组)、持续性房颤组(RHD-cAF组),以行先天性心脏病开胸修补术且为窦性心律组(CHD-SR组)。普通光镜下观察各组患者心房组织结构,苦味酸天狼猩红染色偏振光显微镜分析各组Ⅰ、Ⅲ型胶原容积分数(CVF)及Ⅰ/Ⅲ型CVF比值,Western blot及逆转录多聚酶链反应(RT-PCR)检测各组TGF-β1的表达。结果 RHD-cAF组患者左心房内径(LAd)明显大于RHD-SR组(P<0.05),其余临床资料各组比较差异无统计学意义(P>0.05)。苦味酸天狼猩红染色提示胶原分布于心肌间质中,Ⅰ、Ⅲ型CVF及其比值在CHD-SR组、RHD-SR组、RHD-pAF组和RHD-cAF组逐渐升高,差异有统计学意义(P<0.05)。TGF-β1蛋白和mRNA的表达在CHD-SR组、RHD-SR组、RHD-pAF组和RHD-cAF逐渐增加。结论心房组织纤维化重构是风湿性心瓣膜病患者房颤的重要机制,TGF-β1高表达可能参与心组织房纤维化重构。

Objective To investigate the remodeling of atrial fibrosis in rheumatic heart disease（RHD）patients with atrial fibrillation and its possible mechanism.Methods The clinical data and right atrial tissue specimens were obtained from patients who had undergone mitral valve replacement for rheumatic valvular disease or who had undergone thoracotomy for congenital heart disease in the Second People＇s Hospital of Yibin from Oct.2013 to Oct.2015.According to the heart rhythm characteristics,the specimens obtained from these patients were divided into sinus rhythm group（RHD-SR group,18 cases）,paroxysmal atrial fibrillation group（RHD-pAF group,21 cases）and persistent atrial fibrillation group（RHD-cAF group,42 cases）.The right atrial tissue specimens obtained from those who had undergone thoracotomy for congenital heart disease with sinus rhythm were taken as the control group（CHD-SR group,21 cases）.The structures of atrial tissues were observed under a light microscope.The picric acidsirius red staining was used to detect collagen volume fraction（CVF）of typeⅠandⅢcollagen and the typeⅠ/Ⅲcollagen CVF ratio.The expressions of TGF-β_1 protein and mRNA were detected by using Western blot and reverse transcription polymerase chain reaction（RT-PCR）.Results The left atrial diameter（LAd）in the RHD-cAF group was significantly higher than that in the RHDSR group（P〈0.05）,but no statistically significant difference was found in other clinical data among these groups（P〈0.05）.The results of picric acid-sirius red staining demonstrated that the volume fraction of typeⅠ and typeⅢ collagen and the ratio of typeⅠ/Ⅲ collagen were increased in CHD-SR group,RHD-SR group,RHD-pAF group and RHD-cAF group,gradually,there were statistically significant differences（P〈0.05）.The expression levels of TGF-β_1 protein and mRNA were increased gradually in CHDSR,RHD-SR,RHD-pAF and RHD-cAF groups（P〈0.05）.Conclusion Atrial fibrosis remodeling is an important mechanism of atrial fibrillation in patients with RHD.High expression of TGF-β_1 may be involved in the remodeling of atrial fibrosis.