| Atrial fibrillation (Atrial Fibrillation, AF) has been the most common sustained clinical arrhythmia.From the first report in 1906,to the current atrial fibrillation has become a major public health problems. Our over all prevalence rate of AF was 0.77%, normalized was 0.61 %,by 2050,the incidence of atrial fibrillation would reach 2% in the general population, while in older people The incidence will be higher.The quality of life in patients with AF decreased significantly, while the main hazard of AF is to increase the risk of thromboembolism, AF to increased the risk of stroke in 1.6 ~ 3.5 times ,while the risk of death increased by 50% ~ 90%. For the AF study, that the persistence of atrial fibrosis is its foundation, researchse showed that RAAS is involved in atrial fibrosis, and AngII-AT1 played a key role. APJ was a kinds of new GPCR (G protein-coupled receptor) which was adopted in 1993 the human genome sequencing project,and there is a significant sequence homology between APJ and AT1.apelin is the natural ligand of APJ ,some studies have shown that plasma apelin-12 levels decreased significantly in the patients with lone AF, but for the relationship between the apelin and AF, ACEI drugs on the regulation of apelin has not yet see a detailed report .In this study,by observing the plasma apelin-12 levels and the related degree of atrial fibrosis,and the changes before and after the use of Ramipril,to analysis the relationship between the plasma apelin-12 levels and the degree of atrial fibrosis,study the influence of the ACEI on the level of plasma apelin-12.to evaluate their effect on prognosis for clinical early assessment of the disease, determine prognosis and guide treatment and provide a theoretical basis.Purpose : Through the detection of apelin-12 levels,degree of atrial fibrosis,to discuss the relationship between the plasma apelin-12 levels and the degree of atrial bibrosis, by comparing the level of plasma apelin-12 before and after the use of Ramipril in patients with AF, study the influence of the ACEI on the level of plasma apelin-12.to evaluate their effect on prognosis for clinical early assessment of the disease, determine prognosis and guide treatment and provide a theoretical basis.Methods:From October 2009 to January 2010 ,14 cases who underwent surgical treatment in our hospital were enrolled.Among which,there were 10 patients with AF(3 cases of paroxysmal,7 cases of persistent),4 patients with sinus rhythm.Collecting vein blood(using a tube containing EDTA) before surgery, enzyme linked immunosorbent assay(ELISA) was applied to detect plasma apelin-12 levels.Right atrial appendages were obtained from patients undergoing open heart surgery,placed in 10% formalin fixed,then all the specimens were stained with masson,determined the degree of fibrosis,finally,analysis the correlation between the plasma apelin-12 levels and the degree of atrial fibrosis.At the same time,11 hospitalized cases with AF in the department of cardiology were enrolled,whom over the past 7 days without taking ACEI and ARB drugs.Collecting vein blood(using a tube containing EDTA) at second day after admission,then they were given Ramipril 5mg once orally,Collecting vein blood(using a tube containing EDTA) again before discharge.also detect plasma apelin-12 levels,the date were treated by T test.Results:Compared with the control group, AF group plasma concentrations of apelin-12 was significantly higher (P <0.05), the difference was statistically significant;The plasma apelin-12 concentration did not change significantly (P> 0.05)before and after the use of Ramipril, there are no significant difference; the apelin-12 levels and the degree of atrial fibrosis in a linear relationship,the plasma apelin-12 levels may suggest the degree of atrial fibrosis.Discussion:Atrial fibrillation is usually seen as a system of heart disease or disorders caused by a complex disease, including hypertension, coronary artery disease , valvular heart disease and Cardiomyopathies, etc. The etiology and pathogenesis of atrial fibrillation have been arguing for a long time, but the electrical remodeling, contraction factors and the structural remodeling has been considered there is a synergy of common factors that promote atrial fibrillation,and fibrosis is the signs of arrhythmogenic structural remodeling.A large number of collagen fiber deposition led to the structure of fibrosis, and deposition of collagen fibers are usually degraded as reactive hyperplasia of cardiac rehabilitation arising. Atrial fibrosis is a common feature of atrial fibrillation, atrial fibrosis, for 70% of the patients are secondary to the primary heart disease, but for lone AF patients, 30% of patients have no cause of fibrosis.Atrial fibrosis from a variety of cardiac fibrosis but share a common signaling pathway, Angiotensin II is a characteristic molecular of fibrosis.In hypertension heart disease, CHF, myocardial infarction and cardiac disease, the renin - angiotensin - aldosterone system (RAAS) was found to be related with myocardial fibrosis.Date to show that Ang II was correlated with myocardial apoptosis and interstitial fibrosis, as the collagen proliferation promoting factor activity increased,the degradation of collagen can not offset generation,so the myocardial fibrosis arises.APJ was a kinds of new GPCR (G protein-coupled receptor) which was adopted in 1993 the human genome sequencing project,and there is a significant sequence homology between APJ and AT1.But there is no specific binding between APJ and AgII,apelin is the only known ligand.In the human heart, apelin expression in atrial tissue is 200 times higher than ventricular tissue, and is correlated very well with plasma apelin level.In 2005, Patritk T. Ellinor, Adrian F. Low, and CalumA.MacRae and others have a study on lone AF and plasma apelin-12 levels,obtained the conclusion that in patients with lone atrial fibrillation Apelin-12 levels were significantly reduced compared with control.But for non-lone AF and plasma apelin levels,and the relationship between plasma apelin levels and atrial fibrosis,there are rarely reported.According to this study,the levels of apelin-12 were obvious decreased(p<0.05) compared with control group,the plasma apelin-12 concentrati- on did not change significantly (P> 0.05)before and after the use of Ramipril.In summary, apelin-12 involved in the pathogenesis of atrial fibrillation, patients with a lower level of apelin-12means a heavier atrial fibrosis,which means the prognosis is poor.This will provide a new ideas for the clinical diagnosis and treatment of atrial fibrillation,and offer a positive reference for early assessment of disease, determine prognosis, therapeutic intervention for high-risk patients .Conclusion:AF group plasma apelin-12 level was significantly lower (P <0.05)then control group.the apelin-12 levels and the degree of atrial fibrosis in a linear relationship,the plasma apelin-12 levels may suggest the degree of atrial fibrosis.Ramipril on the regulation of plasma apelin-12 level was not found.
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