老年非瓣膜性心房颤动患者血清Ⅰ型及Ⅲ型前胶原肽及血管紧张素转换酶基因多态性

目的探讨心肌纤维化与老年非瓣膜性心房颤动(简称房颤)的相关性及血管紧张素转换酶(ACE)基因插入/缺失多态性与心肌纤维化的关系。方法50例老年房颤患者及43例非房颤患者。用酶联免疫反应(ELISA)法测定心肌纤维化的指标Ⅰ型前胶原羧基端肽(PⅠP)、Ⅲ型前胶原氨基端肽(PⅢP)。用聚合酶链式反应(PCR)的方法检测ACE基因插入(I)/缺失(D)多态性、并比较不同基因型、不同等位基因的分布及其与PⅠP和PⅢP的关系。结果房颤组血清PⅠP、PⅢP水平均显著高于对照组(P<0.05)。其中房颤合并左室肥厚(LVH)较不合并LVH组PⅠP、PⅢP增高(P<0.05)。房颤合并左房扩大较不合并左房扩大组PⅠP、PⅢP高,但尚无统计学差异(P>0.05)。房颤组与对照组ACEI/D多态性缺失纯合型(DD型)、杂合子(DI型)、插入纯合型(Ⅱ型)基因型频率分别为32%,42%,26%和18.6%,42.2%,37.2%;D等位基因分布频率房颤组较对照组高(P<0.05);DD基因型PⅠP、PⅢP浓度高于DI型和Ⅱ型(P<0.05)。结论老年非瓣膜性房颤患者心肌纤维化指标显著升高;并与房颤伴LVH及左房扩大有关;ACEDD基因型可能是心肌纤维化及心脏重构的危险因素。

The association of polymorphisms in the angiotensin-converting enzyme insertion/deletion gene with nonvulvular atrial fibrillation

Objective To explore the molecular mechanism of atrial fibrillation(AF) by investigating the effects of angiotensin-converting enzyme(ACE) insertion/deletion(I/D) gene polymorphisms in the structural remodeling of atrial myocardium. Methods Fifty patients with AF and 43 non-AF subjects were enrolled. The genotypes of ACE(I/D) gene were identified by polymerase chain reaction (PCR) and PCR-restricted fragment length polymorphism assay (RFLP-PCR). The serum concentration of carboxytermina propeptide of type I procollagen and aminotermianl propeptiden of type Ⅲ procollage were measured by ELISA. Result The frequency of the DD, ID,Ⅱ genotype of ACE in AF group and control group was 32%,42%,26%,and 18.6%,42.2%,37.2% respectively; Allele D genotype frequency was significantly different between AF and controls(P<0.05).The serum concentrations of PⅠP and PIIIP in AF group were higher than that in control group(P<0.05),and were also higher in DD genotype patients than that in DI genotype and IIgenotype(P<0.05); Conclusions The allele D may be the risk factor for AF. The DD genotype of ACE may have significant relationship with the structural remodeling of atrial myocardium.