【摘要】 目的探讨高血压病(EH)合并心房颤动(AF)患者血管紧张素转换酶(ACE)基因插入/缺失(I/D)多态性与转化生长因子β1(TGFβ1)、结缔组织生长因子(CTGF)的关系。方法选择75例EH合并AF患者分为阵发性AF组(EH+p AF,44例)和慢性AF组(EH+c AF,31例),记录一般临床资料及行超声心动图检查,用ELISA法测定血清TGFβ1、CTGF,用PCR方法检测ACE基因插入/缺失(I/D)多态性,并与EH且为窦性心律(SR)组(EH+SR,37例)及健康对照者(NC,36例)进行比较;比较EH+AF组不同基因型间TGFβ1与CTGF的血清浓度。结果 EH+c AF组和EH+p AF组血清TGFβ1及CTGF水平均显著高于EH+SR组和NC组(P<0.01);EH+AF组与EH+SR组、NC组ACE I/D多态性缺失纯合型(DD型)、杂合子(DI型)、插入纯合型(II型)基因型频率比较差异均无统计学意义(P>0.05),但D等位基因分布频率在EH+AF组中较EH+SR组和NC组明显增加(P<0.05);EH+AF组不同基因型之间TGFβ1及CTGF浓度比较发现,DD基因型TGFβ1浓度显著高于DI型(P<0.01)和II型(P<0.01),DD基因型CTGF浓度明显高于II型(P<0.05)。结论 D等位基因可能是高血压病合并心房颤动的易患基因;房颤患者ACE DD基因型TGFβ1和CTGF水平明显升高,藉此可引起心房肌纤维化及心房重构,导致房颤的发生和发展。更多还原

【Abstract】 Objective To explore the relationship between the polymorphisms of angiotensin converting enzyme(ACE) insertion/deletion(I/D) gene and transforming growth factor β1(TGFβ1)/connective tissue growth factor(CTGF) in patients with essential hypertension(EH) and atrial fibrillation(AF). Methods Seventy-five EH patients with documented AF were divided into the paroxysmal AF group(EH + p AF group, n=44) or the chronic AF group(EH+c AF group, n=31), and 37 EH patients with sinus rhythm(SR) were selected into the EH+SR group. All clinical data including blood pressure, lipids, glucose and atrial diameter measured from ultrasonic cardiogram were recorded.Thirty-six healthy subjects from the medical examination center were assigned to normal controls(NC group). The serum TGF β1, CTGF were measured by ELISA method, and the genotypes of ACE(I/D) gene were identified by polymerase chain reaction(PCR) and PCR restricted fragment length polymorphism assay. TGF β1/CTGF concentration and ACE I/D genotypes were compared within different groups. Results The serum TGF β1and CTGF levels of EH+p AF and EH+c AF groups were significantly higher than those of EH+SR and NC group(P<0.001, respectively). In spite of no difference of ACE I/D genotypes between the four groups, allele D genotype frequency in EH+AF group was significantly higher than that in EH+SR and NC groups(P<0.05). Among the patients in EH+AF group, the serum TGF β1concentration was significantly higher in patients with DD genotype than in those with ID and Ⅱ genotypes(P<0.05 and P<0.01, respectively), and the serum CTGF level was also markedly higher in patients with DD genotype than in those with ID and Ⅱ genotypes(P<0.05). Conclusion The allele D may be the risk factor for AF in EH patients. The serum TGF β1/CTGF levels were markedly elevated in AF patients with DD genotype of ACE, which may cause atrial fibrosis and atrial remodeling, resulting in the occurrence and development of atrial fibrillation.更多还原