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目的:探讨非术后心房颤动(房颤)患者外周血中辅助性T淋巴细胞(Th)失衡在不同阶段中的作用。方法:选择房性心律失常患者65例,其中非房颤性房性心律失常(包括房性心动过速、心房扑动、阵发性室性心动过速)22例(AA组)、阵发性房颤21例(Paro-Af组)、持续性房颤22例(Per-Af组);另取性别、年龄、基础疾病相匹配的窦性心律者15名作为对照组。ELISA法检测血清中的干扰素(IFN)-γ、白细胞介素(IL)-4浓度。结果:对照组、AA组、Paro-Af组、Per-Af组血清中IFN-γ水平、IFN-γ/IL-4比值依次升高,而IL-4水平依次降低。对照组、AA组、Paro-Af组的IFN-γ水平、IFN-γ/IL-4比值和IL-4水平均差异无统计学意义,而Per-Af组的IFN-γ水平和IFN-γ/IL-4比值与其他3组比较均差异有统计学意义(均P<0.05)。同时,左房直径与IFN-γ/IL-4比值呈正相关(r=0.752,P<0.01),直线回归方程Y=0.473X+3.267。结论:房颤的病理过程中存在Th的失衡现象,主要见于持续性房颤;Th失衡造成的免疫损伤可能为持续性房颤的发病机制之一。由IFN-γ/IL-4比值与左房直径的关系,推测左房直径大小的改变为正常心肌细胞免疫损伤的结果。
Objective: To investigate the role of imbalance of helper T lymphocytes (Th) in peripheral blood in patients with non-postoperative atrial fibrillation (AF) at different stages. Methods: A total of 65 patients with atrial arrhythmias were selected. Among them, 22 patients (AA group) with non-atrial fibrillation atrial arrhythmia (including atrial tachycardia, atrial flutter and paroxysmal ventricular tachycardia) Atrial fibrillation in 21 cases (Paro-Af group), persistent atrial fibrillation in 22 cases (Per-Af group); another gender, age, basic disease matched sinus rhythm 15 as a control group. Serum levels of interferon (IFN) -γ, interleukin (IL) -4 were measured by ELISA. Results: The levels of IFN-γ and IFN-γ / IL-4 in the serum of control group, AA group, Paro-Af group and Per-Af group increased successively, while IL-4 level decreased in turn. The levels of IFN-γ, IFN-γ / IL-4 and IL-4 in control group, AA group and Paro-Af group had no statistical difference, while the levels of IFN-γ and IFN-γ / IL-4 ratio compared with the other three groups were statistically significant differences (all P <0.05). At the same time, the diameter of left atrium was positively correlated with the ratio of IFN-γ / IL-4 (r = 0.752, P <0.01). The linear regression equation was Y = 0.473X + 3.267. Conclusion: The imbalance of Th exists in the pathological process of atrial fibrillation, mainly in persistent atrial fibrillation. The immune damage caused by Th imbalance may be one of the pathogenesis of persistent atrial fibrillation. According to the relationship between IFN-γ / IL-4 ratio and left atrial diameter, it is speculated that the change of left atrium diameter is the result of normal cardiomyocyte immune injury.