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目的探讨心房颤动(AF)时心房肌细胞钙超载的原因及其在AF发生和维持中的作用。方法采集风湿性心脏瓣膜病窦性心律患者12例(对照组)和AF患者14例(AF组)的右心耳组织,采用RT-PCR方法检测心房肌钙转运调控蛋白mRNA表达水平,测量AF患者左右心房内径、二尖瓣口面积和肺动脉收缩压。结果与对照组相比,AF组患者L-型电压依赖钙通道a1c亚基(LVDCCa1c)、肌浆网Ca2+-ATP酶和兰尼碱受体(RYR2)的mRNA表达水平显著下调(P均<0.01),三磷酸肌醇受体(IP3R1)的mRNA表达水平上调(P<0.05),而磷酸受纳蛋白和肌集钙蛋白的mRNA表达水平无明显改变(P均>0.05)。AF组患者肌浆网Ca2+-ATP酶的mRNA表达水平与左心房内径呈负相关(r=-0.573,P=0.032),与二尖瓣口面积呈正相关(r=0.625,P=0.017);LVDCCa1c的mRNA表达水平与二尖瓣口面积呈正相关(r=0.719,P=0.004)。结论细胞内钙超载机制可能参与了AF的发生和维持,心房肌钙转运调控蛋白mRNA表达异常可能是钙超载的分子生物学机制,钙转运调控蛋白mRNA表达异常与左心房解剖学改变之间存在内在联系。
Objective To investigate the causes of atrial myocyte calcium overload during atrial fibrillation (AF) and its role in the occurrence and maintenance of AF. Methods The right atrial appendage of 12 patients with rheumatic valvular heart disease (control group) and 14 AF patients (AF group) were collected. The expression of calcium transport regulatory protein mRNA in atrial fibrillation was detected by RT-PCR. Left and right atrial diameter, mitral orifice area and pulmonary artery systolic pressure. Results Compared with the control group, the mRNA expression of L-type voltage-dependent calcium channels a1c subunit (LVDCCa1c), sarcoplasmic reticulum Ca2 + -ATPase and Rany (RYR2) were significantly decreased in AF group (all P < 0.01). The mRNA expression of inositol 1,4,5 - trisphosphate receptor (IP3R1) was up - regulated (P <0.05), while there was no significant change in mRNA expression of both phospho - and messenger protein (P> 0.05). The mRNA expression level of sarcoplasmic reticulum Ca2 + -ATPase in AF patients was negatively correlated with the diameter of left atrium (r = -0.573, P = 0.032), positively correlated with mitral valve area (r = 0.625, P = 0.017) LVDCCa1c mRNA expression was positively correlated with mitral orifice area (r = 0.719, P = 0.004). Conclusion The mechanism of intracellular calcium overload may be involved in the occurrence and maintenance of AF. The abnormal mRNA expression of calcium transport regulatory protein in atrial myocardium may be the molecular mechanism of calcium overload. The difference between calcium transport regulatory protein mRNA expression and left atrium anatomy inner relationship.