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目的 分析心房颤动患者循环血浆肾素、血管紧张素Ⅱ(AngⅡ)、醛固酮(Ald)的水平变化,并探讨其临床意义。方法入选42例患者,男19例,女23例,年龄37-80(63.02±10.66)岁。按有无心房颤动病史分为三组:窦性心律组(SR组)14例,阵发性心房颤动组(pAF组)15例,慢性心房颤动组(cAF组)13例。应用放射免疫方法测定循环血浆肾素、AngⅡ、Ald浓度。结果cAF组患者平均左心房直径与SR组和pAF、组相比明显增大(分别增大45.3％和31.8％,P<.01),而且cAF组患者循环血浆肾素、AngⅡ、Ald浓度与SR组相比明显升高(分别升高83.3％、61.7％、34.2％,P<0.01-0.02)。三组患者左心房直径与其循环血浆肾素、AngⅡ、Ald浓度变化具有明显的正相关关系(P<0.05-0.01)。结论心房颤动时存在肾素-血管紧张素系统(RAS)和Ald的激活。RAS和Ald可能参与了心房结构重构的发生。Ald的作用靶点可能主要是心房间质。
Objective To analyze the changes of circulating plasma renin, angiotensin Ⅱ (AngⅡ) and aldosterone (Ald) in patients with atrial fibrillation and to explore its clinical significance. Methods Forty-two patients were enrolled, including 19 males and 23 females, aged 37-80 (63.02 ± 10.66) years. According to whether the history of atrial fibrillation was divided into three groups: sinus rhythm group (SR group) in 14 cases, paroxysmal atrial fibrillation group (pAF group) in 15 cases, chronic atrial fibrillation group (cAF group) in 13 cases. Radioimmunoassay was used to measure circulating plasma renin, AngⅡ, Ald concentrations. Results The mean left atrial diameter of cAF group was significantly higher than that of SR group and pAF group (45.3% vs 31.8%, P <.01 respectively), and the levels of circulating renin, AngⅡ, Ald SR group was significantly higher (83.3%, 61.7%, 34.2%, P <0.01-0.02 respectively). There was a significant positive correlation between left atrial diameter and plasma concentrations of rennin, angiotensin Ⅱ and aldosterone in the three groups (P <0.05-0.01). Conclusion There is renin-angiotensin system (RAS) and Ald activation in atrial fibrillation. RAS and Ald may participate in the occurrence of atrial structural remodeling. Ald targets may be mainly atrial interstitial.