Objective: To investigate the changes in serum levels of endothelin-1 (ET-1) and connective tissue growth factor (CTGF) in patients with atrial fibrillation (AF) and their value for predicting recurrence of AF after radiofrequency ablation (RFCA).
Methods: Sixty-six patients with paroxysmal AF (PaAF) and 72 with persistent AF (PaAF) admitted in our hospital were recruited as AF group and 80 patients with sinus rhythm as the control group, and in all the participants, serum levels of ET-1 and CTGF were measured using ELISA and Western blotting. From 6 patients with AF and 6 with sinus rhythm undergoing cardiac surgery in our hospital, tissue samples of the right atrial appendage were taken intraoperatively for observation of structural changes of the cardiomyocytes, myocardial fibrosis and expression of ET-1 and CTGF protein. In AF group, the patients receiving RFCA were followed up for 6 months following the procedure for assessment of the outcomes.
Results: Compared with the control patients, the patients with AF showed obvious damages of the cardiomyocyte structure and myocardial fibrosis. Serum levels of ET-1 and CTGF levels were significantly higher in PaAF and PeAF groups than in the control group, and were higher in PeAF group than in PaAF group. In the patients with AF, serum ET-1 and CTGF levels were positively correlated with left atrial diameter (LAD) (P < 0.05), and ET-1 was positively correlated with CTGF levels (P < 0.05). In patients with postoperative AF recurrence, the serum levels of ET-1 and CTGF were significantly higher than those in patients without recurrence; serum ET-1 and CTGF levels before and after the operation were positively correlated with the recurrence of PeAF, and elevated serum levels of ET- 1 and CTGF were identified by logistic regression analysis as independent risk factors for postoperative recurrence of PeAF.
Conclusion: Serum levels of ET-1 and CTGF are significantly elevated in AF patients in positive correlation with AF duration. ET-1 and CTGF levels are higher in AF patients with postoperative recurrence, and they both have predictive value for recurrence of PeAF following RFCA.
目的: 探讨内皮素-1（ET-1）和结缔组织生长因子（CTGF）在心房颤动（AF）中的表达变化及对射频消融术后复发的预测价值。
方法: 选取蚌埠医学院第一附属医院心内科就诊的阵发性房颤（PaAF）患者66例和持续性房颤（PeAF）患者72例为实验组，80例窦性心律者为对照组，采用ELISA和Western blot分别检测血清中ET-1和CTGF的表达水平；同时选取我院心脏外科行手术的房颤和窦性心律患者各6例，术中取右心耳组织，采用HE染色和Masson染色分别观察心肌细胞结构形态和心肌纤维化程度，免疫组织化学染色和Western blot检测ET-1和CTGF蛋白表达情况；对实验组行射频消融术的患者开展了为期6个月的临床随访，以评估预后情况。
结果: 与对照组（CON）相比，AF组心肌细胞结构明显被破坏、纤维化程度显著增加；PaAF和PeAF组ET-1和CTGF表达水平明显高于CON组，且PeAF组明显高于PaAF组。在所有实验组中ET-1和CTGF水平与LAD大小呈正相关（P < 0.05），ET-1与CTGF水平呈显著正相关（P < 0.05）。同时，房颤复发组（Re）患者术后ET-1、CTGF水平均高于未复发组（NRe），术前、术后的ET-1和CTGF表达水平与PeAF术后复发呈正相关，且ET-1、CTGF为PeAF术后复发的独立危险因素。
结论: ET-1和CTGF在AF患者中表达明显增加，与AF持续时间呈正相关；ET-1和CTGF在AF复发组患者中表达水平明显升高，且二者对PeAF患者射频消融术后复发有预测价值。
Keywords: atrial fibrillation; clinical prognosis; connective tissue growth factor; endothelin-1; radiofrequency ablation.