CAJ | 학술논문

目的探讨不同类型二尖瓣病变心房肌氧化应激特点及其与心房颤动(AF)的关系.方法 24例二尖瓣病变者,其中二尖瓣狭窄(MS)和二尖瓣关闭不全(MR)各12例(窦性心律各6例,AF各6例).术中切取部分左心耳组织,4例意外死亡者作为对照.免疫组织化学染色评价3-硝基酪氨酸(3-nitrotyrosine,3-NT)表达.比色法检测心肌肌酸激酶(creatine kinase,CK)、肌型肌酸激酶同工酶(MM isoenzyme of creatine kinase,CK-MM)、肌球蛋白ATP酶活性.Western blotting评价心肌CK-MM含量及CK-MM中3-NT的表达.结果所有病人心房肌3-NT表达均明显增高(P＜0.05),AF者表达高于窦性心律者(P＜0.05),MS者表达高于MR者(P＜0.05).病人心肌CK、CK-MM活力均降低(P＜0.05),CK活力与心房肌3-NT表达呈负相关(r=-0.382,P＜0.05),CK-MM活力与其3-NT表达亦成负相关(r=-0.446,P＜0.05).结论二尖瓣病变者心房肌氧化应激反应明显升高,MS者心房肌氧化应激反应高于MR者.心房肌氧化应激与AF的持续存在有关.CK和CK-NN中酪氨酸硝基化可以降低其活力.
목적 탐토불동류형이첨판병변심방기양화응격특점급기여심방전동(AF)적관계.방법 24례이첨판병변자,기중이첨판협착(MS)화이첨판관폐불전(MR)각12례(두성심률각6례,AF각6례).술중절취부분좌심이조직,4례의외사망자작위대조.면역조직화학염색평개3-초기락안산(3-nitrotyrosine,3-NT)표체.비색법검측심기기산격매(creatine kinase,CK)、기형기산격매동공매(MM isoenzyme of creatine kinase,CK-MM)、기구단백ATP매활성.Western blotting평개심기CK-MM함량급CK-MM중3-NT적표체.결과 소유병인심방기3-NT표체균명현증고(P＜0.05),AF자표체고우두성심률자(P＜0.05),MS자표체고우MR자(P＜0.05).병인심기CK、CK-MM활력균강저(P＜0.05),CK활력여심방기3-NT표체정부상관(r=-0.382,P＜0.05),CK-MM활력여기3-NT표체역성부상관(r=-0.446,P＜0.05).결론 이첨판병변자심방기양화응격반응명현승고,MS자심방기양화응격반응고우MR자.심방기양화응격여AF적지속존재유관.CK화CK-NN중락안산초기화가이강저기활력.
Objective The pathogenesis of atrial fibrillation(AF) occurring in patients with cardiac valvular diseases,cardiomyopathy and coronary artery diseases remains unclear.40%～79% of patients with mitral valve diseases requiring surgical intervention were observed to have AF.However,the pathogenesis varies among mitral valve diseases.We try to investigate the characteristics of oxidative stress in the myocardium of the left atrium and the their associations with AF in different forms of mitral valve diseases.Methods Left atrial appendages were obtained from patients with mitral valve disease while they were undergoing mitral valve surgery [n=24;12 with mitral stenosis (MS),6 with AF and 6 in sinus rhythms(SR);12 with mitral regurgitation (MR),6 with AF and 6 in SR)].Control data were obtained from left appendages of 4 persons in normal SR who died of traffic accident.Immunohistochemical method was used for evaluating 3-nitrotyrosine(3-Nr),colorimetric method was used for detection myocardium creatine kinase (CK),MM isoenzyme of creatine kinase (MM-CK) and myosin ATPase,and the contents of MM-CK and MM-CK tyrosine nitration were determined with western blotting.Results The expression of 3-NT was increased throughout the atrial myocardium in the patients with mitral valve disease as compared with that in the controls (P＜0.05).The immunoreactivity of 3-NT was higher significantly in the patients with AF than those in SR (P＜0.05),and was higher significantly in patients with MS than those with MR (P＜0.05).Significantly decreased activities of CK and MM-CK were observed in the myocardium from patients with mitral valve diseases,as compared with that in the controls (P＜0.05).Correlation analysis demonstrated that an inverse correlation existed between CK activity and 3-NT expression in the atrial tissues(r=-0.382,P＜0.05).There was also an inverse correlation between MM-CK activity and extent of MM-CK tyrosine nitration (r=-0.446,P＜0.05).Conclusion Response to coridative stress was increased significantly in the myocardium of the left atrium in the patients with mitral valve disease,and the response was higher in the patients with MS than in the patients with MR.Qxidative stress relates not only to mitral valve disease,but also relates to the development and persistence of AF.The formation of 3-nitrotyrosine in CK and MM-CK may damage the activities of them.