心衰患者心肌中NHE1 mRNA的表达与血浆内皮素及心肌胶原的相关性研究

目的:观察心力衰竭(HF)患者心肌组织中钠氢交换体1（natrium-hydrogen exchanger 1，NHE1）的表达及其与血浆内皮素-1(ET-1)及心肌胶原的相关性，探讨NHE1、ET-1在HF、心肌纤维化发生发展中的作用。方法: 采用实时荧光定量PCR（FQ-PCR）检测35例HF患者心肌组织中NHE1 mRNA的表达水平。采用放射免疫分析法分别测定受试者血浆ET-1及Ⅰ型前胶原羧基端肽Ⅰ（PⅠCP）和Ⅲ型前胶原氨基端肽（PⅢNP）的含量。同时用心脏多普勒超声检查心脏左房内径、左室射血分数（LVEF％）。结果: FQ-PCR检测心功能Ⅰ、Ⅱ、Ⅲ级组HF患者心肌组织中NHE1 mRNA的△Ct值，分别为6.29±0.66、5.01±0.60和4.40±0.74。心功能Ⅱ级、Ⅲ级组患者心肌组织中NHE1 mRNA的表达明显高于心功能Ⅰ级组（P<0.01），心功能Ⅲ级组患者心肌组织中NHE1 mRNA的表达明显高于心功能Ⅱ级组（P<0.05）。HF组ET-1及PⅠCP、PⅢNP的含量较对照组明显升高（P<0.01），并随着HF程度的加重而增加，心功能Ⅱ级和Ⅲ级组显著高于心功能Ⅰ级组（P<0.05，P<0.01），心功能Ⅲ级组显著高于心功能Ⅱ级组（P<0.05）；且ET-1及PⅠCP、PⅢNP的含量与NHE1 mRNA的△Ct值（r=-0.587，P<0.01）呈显著的负相关。ET-1与PⅠCP、PⅢNP含量（r=-0.418，P<0.05）呈显著的正相关。结论: HF患者NHE1 mRNA的表达与ET-1及PⅠCP、PⅢNP的含量均密切相关。NHE1在HF、心肌纤维化的发生和发展过程中可能起着重要作用。

Relationship between expression of myocardial sodium-hydrogen exchanger 1 mRNA and endothelin and serum collagen in patients with chronic heart failure

AIM:To investigate the relationship between expression of myocardial sodium-hydrogen exchanger 1 (NHE1) mRNA and endothelin (ET-1) procollagen type I (PICP) and procollagen type Ⅲ (PIIINP) in patients with chronic heart failure (CHF). METHODS: Expressions of NHE1mRNA in 35 heart failure patients were detected using real-time fluorescence quantitative PCR (FQ-PCR). Plasma levels of ET-1, PⅠCP and PIIINP were tested by special radioimmunoassay. Left atrial diameter and left ventricular ejection fraction were measured by Doppler echocardiography. RESULTS: Using the real-time fluorescence quantitative PCR method, △Ct value of class I group, class II group and class Ⅲ group were 6.29±0.66, 5.01±0.60, and 4.40±0.74, respectively. Expressions of myocardial sodium-hydrogen exchanger 1 mRNA in group of class II and class III were significantly higher than in class I group (P<0.01). The expression of myocardial sodium-hydrogen exchanger 1 mRNA in group of class III was significantly higher than in group of class II (P<0.05). Plasma levels of ET-1, PICP and PIIINP in CHF were significantly higher than those in control group and the levels of ET-1, PICP and PIIINP were upregulated significantly by cardiac function classes according to the New York Heart Association. ET-1, PICP and PIIINP were negatively correlated with NHE1 mRNA △Ct and NHE1 mRNA △Ct was negatively correlated with ET-1. CONCLUSION: Change of expression of NHE1 mRNA in patients with CHF is possibly one of the molecule mechanisms of myocardial remodeling and is related to the genesis and maintenance of heart failure. NHE1, ET-1, PⅠCP and PIIINP are positively related. NHE1 may play an important role in the occurrence and development of heart failure.