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转化生长因子β1的表达与风湿性心脏病慢性心房颤动射频消融疗效的关系

Rheumatic valvular surgery and concomitant radiofrequency Maze procedure: TGFβ1 mRNA expression predicting the efficacy

摘要:

目的 探讨转化生长因子β1(TGF-β1)的mRNA表达与风湿性心脏病慢性心房颤动(简称房颤)患者射频消融疗效的关系.方法 2008年1月至9月,40例瓣膜手术同期行射频消融术的风湿性心脏病慢性房颤患者,术中获取左心耳,根据术后6个月的随访结果分为房颤消除组及房颤未消除组;以同期行瓣膜手术的风湿性心脏病窦性心律患者10例为对照.通过苦味酸大狼猩红染色法分析心房组织中Ⅰ型及Ⅲ型胶原容量分数(CVF-Ⅰ和CVF-Ⅲ),RT-PCR法检测TGF-β1的mRNA表达.结果 至随访结束,40例房颤患者有28例房颤消除,12例未消除.与窦性心律组相比,房颤消除组和房颤末消除组患者心房组织TGF-β1的mRNA表达、CVF-Ⅰ及CVF-Ⅰ/CVF-Ⅲ比值依次增加(P<0.05).房颤消除组中左心房功能未恢复的患者心房组织TGF-β1 mRNA表达高于左心房功能恢复患者(P<0.05).心房组织TGF-β1 mRNA表达与CVF-Ⅰ及左心房直径均呈正相关(r=0.786和0.858,P<0.05).Logistic回归分析发现,影响同期射频消融术疗效的危险因素有TGF-β1 mRNA表达水平(OR=1.13,95%CI 1.05~1.18,P=0.031)、CVF-Ⅰ(OR=1.07,95%CI 1.00~1.13,P=0.037)及左心房直径(OR=2.23,95%CI 1.08~4.59,P=0.042).结论心房组织TGF-β1的mRNA表达程度在房颤患者心房结构重构中起重要作用,并影响外科射频消融治疗后窦性心律的维持及心房的功能恢复.

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abstracts:

Objectives To investigate the relationship of the transforming growth factor betal (TGF-β1)mRNA expression in atrial myocardium and the effectiveness of radiofrequency Maze procedure in patients with rheumatic valvular disease(RHD)and permanent atrial fibrillation(AF).Methods Between January 2008 and September 2008,40 patients with RHD and AF underwent a radiofrequency Maze procedure with concomitant valvular Burgery.The patients were assigned to normal sinus rhythm(SR)group (group A)and persistence AF group(group B)according to the results of the 6-month follow-up.Another 10 patients with SR and RHD undergone valvular surgery alone were assigned to control group(group C).Left atrial appendage were obtained in all patients.Expressions of TGF-β1 mRNA were detected by semiquantitative RT-PCR technique.CVF-Ⅰ and CVF-Ⅲ were observed by sirius red staining.Results At 6-month follow-up,there were 28 patients in group A and 12 in group B.Patients in group A and group B had higher mRNA expressions of TGF-β1,CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ compared with group C(P<0.05).Also,the group B had higher mRNA expressions of TGF-β1,CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ than group A(P<0.05).The patients who had return of functional atrial contraction in group A had lower mRNA expression than the non-return patients(39±12 vs.60±12,P<0.05).The TGF-β1 mRNA expression had a correlation with both the contents of CVF-Ⅰ and left atrial diameter(r=0.786,P<0.05;r=0.858,P<0.05).Multiple logistic regression analysis revealed that the risk factors which independently associated with the postoperative persistence of atrial fibrillation at 6-month follow-up includes mRNA expression levels of TGF-β1(OR=1.13,95%CI 1.05-1.18,P=0.031),CVF-Ⅰ(OR=1.07,95%CI 1.00-1.13.P=0.037)and lett atrial diameter(OR=2.23,95%CI 1.08-4.59,P=0.042).Conclusions The atrial TGF-β1 mRNA expression level could predict the persistence of AF and the return of the functional atrial contraction at 6-month follow-up in patients who underwent rheumatic valvular surgery and concomitant radiofrequency Maze procedure.

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