中文摘要：

目的通过分析多种氧化应激标志物在血清及组织中的动态变化,观察其在心房结构重构中的表达,探讨房颤（atrial fibrillation,AF）的发生机制。方法选择我中心44例2014年2-5月行单纯二尖瓣置换手术的风湿性心脏病患者,根据病史及术前动态心电图记录分为2组：持续性房颤（AF）组26例,窦性心律（SR）组18例。术中取部分右心耳组织,行Masson染色观察纤维化情况,采用免疫组化、免疫荧光染色法观察右心耳组织NOX2蛋白表达,用ELISA法测定右心耳组织中丙二醛（malondialdehyde,MDA）、超氧化物歧化酶（superoxide dismutase,SOD）、活性氧（reactive oxygen species,ROS）、晚期氧化蛋白产物（advanced oxidative protein products,AOPP）浓度以及血清中ROS、AOPP含量。结果 AF组心房组织中MDA[（15.41±1.69）μmol/mg]、SOD[（13.32±1.25）μmol/mg]、ROS[（18.53±3.47）μmol/mg]、AOPP[（29.69±2.09）μmol/mg]含量与SR组MDA[（11.46±1.83）μmol/mg]、SOD[（10.65±1.15）μmol/mg]、ROS[（13.65±3.29）μmol/mg]、AOPP[（21.94±1.94）μmol/mg]比较差异有统计学意义（P〈0.05）,AF组血清中ROS含量[（34.6±2.61）μmol/L]明显高于SR组[（17.8±1.03）μmol/L],2组患者血清中AOPP含量差异无统计学意义（P〉0.05）。与SR组相比,AF组右心耳组织胶原纤维增生明显,NOX2蛋白表达呈强阳性。结论房颤时发生以间质纤维化改变的心房结构重构,氧化应激参与了房颤发生和结构重构过程。

英文摘要：

Objoctive To detect the levels and the dynamic expression levels of several oxidative stress biomarkers in the serum and cardiac tissues during atrial remodeling in atrial fibrillation patients in order to investigate the underlying mechanism of atrial fibrillation development. Methods A total of 44 patients with rheumatic heart disease undergoing mitral valve replacement in our center from February to May 2014 were enrolled in the present study. The patients were divided into 2 groups according to their history and preoperative electrocardiography （ECG） reports, that is persistent atrial fibrillation group （AF, n = 26） and sinus rhythm group （ SR, n = 18 ）. Right auricle tissue samples were obtained during the operation, and then stained by Masson trichrome staining to examine the degree of fibrosis. The protein expression of NOX2 was measured by immunohistochemical assay and laser confocal microscopy. Oxidative stress was estimated by the amount of malondialdehyde （MDA）, superoxide dismutase （SOD）, reactive oxygen species （ROS）, advanced oxidative protein products （AOPP） in the right auricle, and by the serum levels of ROS and AOPP by enzyme-linked immunosorbent assay （ELISA）. Results Significant differences were seen in the amount of MDA （ 15.41 ± 1.69 vs 11.46 ± 1.83 molting）, SOD （ 13.32 ± 1.25 vs 10.65 ± 1.15 mol/mg）, ROS （18.53 ±3.47 vs 13.65 ±3.29 mol/mg）, AOPP （29.69±2.09 vs 21.94 ±1.94 mol/mg） between the AF group and SR group （ P 〈 0.05 ）. The serum ROS level was higher in the AF group than SR group （34.6 ± 2. 61 vs 17.8 ± 1.03 mol/L）, but there was no obvious difference in that of AOPP （P 〉0.05）. Compared to the SR group, the AF group had markedly more collagenous fibers and stronger NOX2 protein expression in the fight auricle. Conclusion Myocardial interstitial fibrosis is the main characteristics of atrial structural remodeling in atrial fibrillation, and oxidative stress is involved in the process of atrial fibrillation and