摘要
目的探讨房颤(AF)患者血清溴结构域蛋白4(BRD4)的表达及临床意义。方法选取AF患者和阵发性室上性心动过速患者分别作为AF组[n=74,分为阵发性AF(阵发)组和持续性AF(持续)组]和对照(PSVT)组(n=73),取所有患者清晨空腹静脉血,采用实时荧光定量逆转录PCR(qRT-PCR)法检测血清BRD4水平,采用胸超声心动图测量AF组和PSVT组患者术前左心房前后径(LAAPD)及左心室射血分数(LVEF);采用食道超声心动图检测AF组患者术前24 h的左心耳最大排空流速(LAA-PEV);采用左心房高密度基质标测检测AF组患者术中左心房局部双极电压,据双极电压大小分为左心房低电压(LAVs)组(双极电压<0.5 mV)和正常电压(NLAVs)组(双极电压≥0.5 mV),其中LAVs组AF患者根据LAVs数量多少分为轻度组(1个LAVs)及中度组(2个及以上LAVs);随访AF组患者术后第3~12个月AF的复发情况,据术后随访复发情况分为复发组(reAF组)和未复发组(SR组);采用Spearman分析AF组患者血清BRD4与LAAPD、LVEF、LAA-PEV、左心房低电压、术后复发等指标的相关性。结果AF组患者血清BRD4、LAAPD均高于PSVT组(P<0.05),LVEF低于PSVT组(P<0.05);持续组AF患者术后复发例数、左房低电压例数、BRD4水平及LAAPD高于阵发组(P<0.05),LVEF及LAA-PEV低于阵发组(P<0.05);LAVs组AF患者外周静脉血BRD4水平、LAAPD高于NLAVs组(P<0.05),LVEF、LAA-PEV低于NLAVs组(P<0.05);中度组LAVs患者外周静脉血BRD4水平高于轻度组(P<0.05),LVEF低于轻度组(P<0.05);reAF组AF患者左房低电压例数、BRD4水平、LAAPD均高于SR组(P<0.05),LVEF、LAA-PEV低于SR组(P<0.05)。结论AF患者血清BRD4表达升高,可能对AF严重程度及术后复发具有一定的预测价值。
Objective To investigate the expression and clinical significance of serum bromodomain-containing protein 4(BRD4)in patients with atrial fibrillation(AF).Methods Patients with AF and patients with paroxysmal supraventricular tachycardia(PSVT)were chosen as AF group[n=74,further divided into paroxysmal AF group and sustained AF group]and control group(PSVT)group(n=73).fasting venous blood samples were collected from all patients in the morning.Serum BRD4 levels were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction(qRT-PCR).Transthoracic echocardiography was performed to measure left atrial anteroposterior diameter(LAAPD)and left ventricular ejection fraction(LVEF)of AF groups and PSVT groups before operation.Patients in the AF group underwent transesophageal echocardiography within 24 hours before operation to measure left atrial appendage peak emptying velocity(LAA-PEV).The left atrial local bipolar voltage was measured by high-density matrix mapping.According to the bipolar voltage,the AF patients were divided into LAVs group(bipolar voltage<0.5 mV)and normal voltage(NLAVs)group(bipolar voltage≥0.5 mV).According to the number of LAVs,patients in the LAVs group were divided into mild group(1 LAVs)and moderate group(2 or more LAVs).AF recurrence was followed up for 3 to 12 months after surgery in AF group.According to the recurrence after surgery,AF group was further divided into recurrence group(reAF group)and non-recurrence group(SR group).Spearman was used to analyze the correlation between serum BRD4 and LAAPD,LVEF,LAA-PEV,left atrial low voltage,postoperative recurrence and other indicators in AF group.Results The serum levels of BRD4 and LAAPD in AF group were higher than those of PSVT group(P<0.05),and LVEF was lower than that of PSVT group(P<0.05).Compared with the paroxysmal AF group,the number of recurrent AF patients,the number of left atrial low voltage patients,the BRD4 level and LAAPD in the sustained AF group were significantly higher(P<0.05).The levels of BRD4 and LAAPD in peripheral venous blood of AF patients in LAVs group were higher than those of NLAVs group(P<0.05),and LVEF and LAA-PEV were lower than those of NLAVs group(P<0.05).The peripheral venous blood BRD4 level in the moderate LAVs group was higher than that of mild group(P<0.05),and LVEF was lower than that of mild group(P<0.05).The number of left atrial low voltage,BRD4 level and LAAPD in reAF group were higher than those of SR group(P<0.05),LVEF and LAA-PEV were lower than those of SR group(P<0.05).Conclusion Serum BRD4 expression level significantly increased in AF patients,which might have certain predictive value for the severity and postoperative recurrence of AF.
作者
王龙
钟莉莉
周海燕
李永康
陈章荣
李伟
WANG Long;ZHONG Lili;ZHOU Haiyan;LI Yongkang;CHEN Zhangrong;LI Wei(Department of Cardiovascular Medicine,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;School of Clinical Medicine,Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Neurology,the Second People's Hospital of Guiyang,Guiyang 550081,Guizhou,China)
出处
《贵州医科大学学报》
CAS
2024年第3期423-429,共7页
Journal of Guizhou Medical University
基金
贵州省科技计划项目(黔科合基础-ZK〔2023〕一般374)。
关键词
心房颤动
复发
溴结构域蛋白4
心房纤维化
低电压
左心耳最大排空流速
atrial fibrillation
recurrence
bromodomain-containing protein 4
atrial fibrosis
low-voltage
left atrial appendage peak emptying velocity
