中文摘要：

目的观察嗜铬粒蛋白A（chromogranin A，CGA）在扩张型心肌病（dilated cardiomyopathy，DCM）患者中的表达、心肌纤维化程度及二者间的关系，初步探讨CGA在心肌纤维化进程中的作用。方法取DCM心脏移植患者的心肌组织标本作为研究对象，排除心脏疾病的脑外伤尸检心肌组织标本作为对照。利用实时荧光定量聚合酶链反应（real-timePCR）检测心肌中CGA及Ⅰ型胶原纤维（COLⅠ）、Ⅲ型胶原纤维（COLⅢ）、ADAMTS-1的mRNA表达，并分析其基因学相关性。免疫组织化学技术鉴定心肌中CGA的分布位置及其表达强弱变化。运用苦味酸天狼猩红特异染色和偏振光显微镜显像，并辅以图像分析软件计算心肌胶原容积积分（CVF）。并对CGA与心肌纤维化的相关性进行形态学上的比较。结果real-timePCR证实心肌中CGA-mRNA和COLI-mRNA、COLⅢ-mRNA、ADAMTS-1．mRNA三者均具有相关性，相关系数分别为0．729、0．95、0．665。免疫组织化学结果表明，DCM患者心肌中CGA表达增加（P〈0．05）。DCM患者心肌CVF高于正常心肌（P〈0．001）。形态学上，CGA呈现阳性的部位及其分布密集区域的附近，心肌纤维化明显。结论DCM心肌中CGA的表达与心肌纤维化具有相关性，推测DCM患者心肌组织中CGA的表达水平影响着心肌纤维化的发展。

英文摘要：

Objective To observe the possible correlation between expression of chormogranin A （CGA） and myocardial fibrosis and investigate the potential role of CGA in the development of myocardial fibrosis in patients with dilated cardiomyopathy （ DCM ）. Methods Surgical myocardial specimen from 10 DCM patients underwent successful orthotopic cardiac transplantation, and 3 normal myocardial specimen from brain-dead organ donors were obtained. CGA-mRNA, COL Ⅰ-mRNA, COL Ⅲ-mRNA and ADAMTS-1- mRNA were analyzed by real-time PCR. The location and expression of CGA were assessed by immunohistochemistry（INH） with anti-CGA antibody. The collagen specific picrosirus red staining was applied on transversal myocardial slides and the collagen volume fraction （CVF） was calculated. The correlation between CGA and CVF was analyzed. Results Cytoplasic expression of CGA assessed by INH showed large amount of strong positive granules densely arranged in the epicardial and endocardial myocardiocytes in DCM specimen while there was only few sparse granules in the normal myocardium （ P 〈 0. 05 ）. CVF was significantly higher in DCM myocardial specimen than that in normal specimen （P 〈 0. 001 ）. CGA-mRNA was significantly correlated with COLⅠ-mRNA （r = 0. 729）, COLⅢ-mRNA （ r = 0. 95 ） and ADAMTS-I-mRNA （ r = 0. 665, all P 〈 0. 05 ）. Moreover, collagen deposition location was almost identical with the strong positive expression location of CGA. Conclusion We demonstrated for the first time that the deposition of CGA was related with the myocardial fibrosis in DCM heart, therefore, CGA might play an important role by influencing myocardial remodeling and fibrosis in DCM patients.