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目的检测风湿性心脏病(风心病)心房颤动(房颤)患者心房组织纤维化程度,Ⅰ型胶原、Ⅲ型胶原、增殖细胞核抗原的基因表达和蛋白水平,探讨房颤患者心房组织纤维化的分子机制。方法75例风心病接受换瓣手术者分为三组,其中窦性心律组34例;阵发性房颤组11例;持续性房颤组30例,于术中获取右心耳组织约250mg,采用半定量逆转录-聚合酶链反应(RT-PCR)技术测定心房组织中Ⅰ型胶原、Ⅲ型胶原和增殖细胞核抗原(PCNA)的mRNA含量,采用苦味酸天狼猩红染色法对心房组织胶原沉积量及分布情况进行分析,采用免疫组织化学方法对PCNA蛋白水平及分布情况进行分析。结果与窦性心律组比较,阵发性房颤患者患者心房组织中PCNA基因的mRNA及蛋白表达水平均明显增加(p<0.001;P<0.01);与窦性心律组比较慢性房颤患者心房组织中PCNA基因的mRNA及蛋白表达水平均明显增加(p<0.001;p<0.001);与阵发性房颤患者比较,慢性颤患者心房组织中PCNA基因的mRNA及蛋白表达水平明显增加(p<0.01;p<0.05)。结论心房组织中PCNA基因表达上调可能是导致房颤患者心房纤维化的分子机制之一,可能与房颤的发生和维持有关。
Objective To investigate the degree of atrial fibrosis, the expression of type Ⅰ collagen, type Ⅲ collagen and proliferating cell nuclear antigen in rheumatic heart disease (rheumatic heart disease) patients with atrial fibrillation (AF) and the protein levels of atrial fibrillation Molecular mechanism. Methods Seventy-five patients with rheumatic heart disease undergoing valve replacement surgery were divided into three groups, including 34 cases of sinus rhythm group, 11 cases of paroxysmal atrial fibrillation group and 30 cases of persistent atrial fibrillation group. The right atrial appendage was obtained about 250 mg during operation, The contents of mRNA of type Ⅰ collagen, type Ⅲ collagen and proliferating cell nuclear antigen (PCNA) in atrial tissue were determined by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). The effects of picric acid Sirius red staining on atrial tissue collagen Sedimentation amount and distribution were analyzed, the immunohistochemical method of PCNA protein levels and distribution were analyzed. Results Compared with sinus rhythm group, the expression of PCNA mRNA and protein in atrial tissue of patients with paroxysmal atrial fibrillation were significantly increased (p <0.001; P <0.01); Compared with sinus rhythm group, (P <0.001; p <0.001). Compared with patients with paroxysmal atrial fibrillation, the mRNA and protein expression levels of PCNA gene were significantly increased in chronic atrial fibrillation patients (p <0.01; p <0.05). Conclusion The up-regulation of PCNA gene expression in atrial tissue may be one of the molecular mechanisms leading to atrial fibrosis in atrial fibrillation patients, which may be related to the occurrence and maintenance of atrial fibrillation.