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慢性的なミトラルリグルジテーションの患者における心筋前炎症性サイトカイン発現と左心房リモデリング
Hakan Oral1, Natarajan Sivasubramanian, David B Dyke
1Division of Cardiology, University of Michigan and Veterans Affairs Medical Centers, Ann Arbor, USA. oralh@umich.edu
Circulation
|February 20, 2003
まとめ
慢性ミトラル逆流 (MR) は,患者の心筋腫瘍死滅因子-アルファ (TNF-alpha) を増加させる. ミトラ弁修復手術は,TNF-αを減少させ,左心室の改造を改善し,MRにおけるTNF-αの役割を示している.
科学分野:
- 心血管生物学 心血管生物学
- 分子医学は分子医学である.
- 心臓外科手術について
背景:
- ストレッチは,動物モデルにおける心筋腫瘍死滅因子-α (TNF-α) を誘導する.
- 慢性的なミトラル逆流 (MR) は,左心室 (LV) の体積過負荷を引き起こします.
- この研究では,MR患者におけるLVボリュームオーバーロードによるTNF-α誘導を調査しています.
研究 の 目的:
- MR患者におけるLVボリュームオーバーロードが心筋および全身TNF-α発現を誘発するかどうかを判断する.
- TNF-α発現とLVリモデリングの関係を評価する.
- ミトラル弁 (MV) 修復がTNF-αレベルとLV再構成に与える影響を評価する.
主な方法:
- プラズマTNF-αと受容体を測定した26人のMR患者のMV修復前と9人のMV修復後.
- RT-PCRによる11人のMR患者と10人のドナー心臓の定量化された心筋TNF-αmRNA.
- 関連心筋TNF-α発現は,LV容量とリモデリングパラメータと相関しています.
主要な成果:
- MR患者では,対照群と比較して,プラズマTNF-αと受容体の値が上昇した.
- 心筋TNF-α mRNAは,MRI患者では,ドナー心臓よりも有意に高かった.
- MV修復により,血のTNF-αレベルと受容体が低下した.
- 心筋TNF-αは,LVの体積と相関し,手術後のLVリモデリングと逆相関した.
結論:
- TNF-αは,MR患者の心筋と血に発現する.
- ミトラ弁の手術はTNF-αの発現を逆転させ,LVの体積過負荷を軽減します.
- TNF-α発現は,MRにおけるLV再構成と関連しており,その病原性における役割を示唆している.
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