二尖瓣病变患者血浆血管紧张素转换酶水平与心房颤动的关系

目的探讨二尖瓣病变患者血管紧张素转换酶（angiotensin converting enzyme，ACE）水平与持续性心房颤动（atrial fibrillation，Af）的关系。方法124例拟行心瓣膜置换术的二尖瓣病变患者纳人本研究，所有患者术前均进行血生化、心电图、彩色超声心动图及胸部X线片检查。根据是否伴有持续性Af将124例患者分为窦性心律（sinus rhythm，SR）组（SR组）和Af组；在Af组，根据患者的二尖瓣病变类型，进一步分为二尖瓣狭窄（mitral stenosis，MS）伴Af组（MS—Af组）和二尖瓣反流（mitral regurgitation，MR）伴Af组（MR—Af组）。采用竞争放射免疫法测定各组的ACE水平。结果二尖瓣病变患者中47．58％（59／124）伴有Af，与二尖瓣反流相比，二尖瓣狭窄较多伴有持续性Af（60．53％vs．27．08％，P〈0．05）。Af组的血浆ACE水平明显高于SR组（72．60±22．03U／L vs．56．40±17．96U／L，P〈0．05）。在Af患者中，MS—Af组的ACE水平高于MR—Af组（82．92±18．75U／L vs．66．25±21.10U／L，P〈0．05），且易伴有血栓。多元回归分析显示：Af与ACE水平（r=0．089，P=0．021）及左房直径（r=0．447，P=0．033）有关。结论二尖瓣病变患者血浆ACE水平升高与Af发生有关，在二尖瓣狭窄伴Af的患者中ACE水平升高更为明显；ACE水平与左心房血栓形成有一定的关系。

Plasma Angiotensin Converting Enzyme Level and Permanent Atrial Fibrillation with Mitral Valvular Disease

Objective To investigate whether angiotensin converting enzyme （ACE） have significant relation to permanent atrial fibrillation （Af） with mitral valvular diseases. Methods 124 consecutive lone mitral valvular disease patients who need surgery were studied. At baseline, all patients underwent a physical examination, 12-lead electrocardiography and echoeardiography. The plasma ACE level was measured in all patients by a radioimmunoassay technique. Patients who had permanent Af formed the Af group, and those who still kept sinus rhythm （SR） comprised the SR group. In Af group, patients were separated into two groups by the subgroup of mitral valvular disease mitral stenosis（MS） and mitral regurgitation（MR）], then formed MS Af group and MR-Af group. Results Af was diagnosed in 47.58G （59/124） of lone mitral valvular disease patients. Patients who had Af were older （by 6 years） than sinus rhythm patients and more frequently had a history of stroke. Mitral stenosis patients were easy to have Af （60.53% vs. 27. 08%, P〈0.05）. The plasma level of ACE was significantly higher in Af group than that in SRgroup （72.60 ±22.03 U/L vs. 56.40±17.96 U/L, P〈0.05）. In Afgroup, the ACE level in MS-Afgroup was higher than that in MR-Af group （82. 92±18. 75 U/L vs. 66.25±21. 10 U/L, P〈0.05）. Mitral stenosis patients more frequently had a history of stroke than that of mitral regurgitation patients. Af correlated significantly with the level of ACE （r=0. 089, P=0. 021） and left atrial dimension （r= 0. 447, P=0. 033）. Conclusion We validated and extended the hypothesis that increasing ACE level predicted an increasing risk of Af in mitral valvular diseases. It was expressed significantly in mitral stenosis patients especially.