| Objective: Tissue fibrosis is an important link in the terminal stage of many diseases,causing organ function damage and failure,seriously endangering human health and even life safety,and it is difficult to treat.With the research progress of molecular biology,people have found many kinds of ways to participate in the fibrosis of the occurrence and development of diseases,including transforming growth factor(TGF)signal transduction pathway,blood vessels,source sex growth factor beta(PDGF-beta)receptor mediated signal transduction pathways and prostaglandin oxidoreductase within 2(cox-2),diffuse extracellular matrix and oxidative stress mediated ways and so on.Among them,TGF-β signal transduction pathway is one of the most important ways affecting the occurrence and development of fibrosis.BMP(BMP)is transforming growth factor beta(TGF-beta)growth factor superfamily member and initially identified as bone cells induced factors,is one of the downstream members of TGF-beta,and gremlin as BMP antagonist,involved in a variety of fibrosis,the occurrence of diseases,related to the occurrence of a variety of fibrosis diseases,such as kidney,lung,liver,bone arthritis and fibrous changes,etc.Overseas studies by Jasmin Wellbrock et al.showed that gremlin-1 can lead to the occurrence and development of pulmonary hypertension,which is a potential new biomarker for patients with pulmonary hypertension and can be directly related to the underlying pathological mechanism.Loredana Ciuclan et al.applied anti-gremlin-1 antibody to the treatment in mice,which reduced the remodeling of pulmonary vessels and right ventricular hypertrophy,confirming that gremlin-1 is a potential therapeutic target for pulmonary hypertension.One of the mechanisms of atrial fibrillation is fibrosis of the atrial muscle leading to atrial remodeling.Has a large number of studies have shown that gremlin-1 in many organs such as lung,liver,kidney,and pancreatic fibrosis played an important role in the process of occurrence,development,and even the myocardial biopsy in patients with heart failure(hf)also found the expression of gremlin-1,and the higher the degree of myocardial fibrosis,gremlin-1expression quantity is higher,gremlin-1 is associated with left ventricular dysfunction,within half a year is a risk factor for death or hospitalization again.However,the expression and clinical significance of gremlin-1 in patients with atrial fibrillation have not been reported.Therefore,this study mainly investigated the clinical significance of gremlin-1 by detecting the expression of serum gremlin-1 in patients with NVAF.Methods: Patients diagnosed with NVAF without heart failure,heart failure without atrial fibrillation,and NVAF with heart failure were enrolled in our hospital from December 2018 to October 2019.According to the diagnosis,patients with NVAF without heart failure were classified into three groups.Patients with NVAF combined with heart failure were labeled as AFHF group.Patients with heart failure without atrial fibrillation were labeled as HF group.At the same time,normal volunteers were collected as the control group,4ml venous blood was extracted for centrifugation,the supernatant was taken,and the level of gremlin-1 in the plasma supernatant was detected by elisa.All patients with atrial fibrillation and heart failure were given standard drug therapy.All the research object in our ultrasound heart ultrasound,and recorded before and after the left atrium diameter,about right atrium diameter,left ventricular diastolic final diameter and ejection fraction,left ventricular end-diastolic volume and left ventricular end systolic volume,at the same time,all the researchers in our hospital clinical laboratory complete routine blood,C-reactive protein(CRP),brain n-terminal natural peptide precursor protein(NT-pro BNP),myocardial enzymes,such as liver and kidney function routine,biochemical examination.Results: A total of 28 subjects(64.89±7.87 years old,17 males and 11females)were included in AF group.A total of 30 subjects(63.77±7.79 years old,19 males and 11 females)were included in THE AFHF group.A total of 30subjects(63.10±8.41 years old,19 males and 11 males)were included in HF group.A total of 20 subjects(61.80±9.10 years old,12 males and 8 females)were included in the control group.General information such as gender,age,white blood cell count,C-reactive protein,liver and kidney function,hypersensitive troponin and other general information were not significantly different between the groups.In the comparison of NT-prob NP,there was no statistically significant difference between the AFHF group(6229.90±2580.73pg/ml)and the HF group(5650.30±3313.85pg/ml),but it was significantly higher than the AF group(1199.04±941.93pg/ml)and the control group(204.46±126.97pg/ml),and the difference between the groups was statistically significant(P < 0.01),and the difference between the patients with atrial fibrillation without heart failure and the normal control group was also statistically significant.Compared with the other two groups,LVEDD,LVEDV and LVESV in the AFHF group were larger,and the difference was statistically significant.In terms of LVEF,THE HF group was the lowest,followed by the AFHF group and AF group,with statistically significant differences.The serum gremlin-1 levels in AFHF group(2451.07±546.75ng/ml)and HF group(2537.36±539.21ng/ml)were higher than those in AF group(2127.35±314.84ng/ml)and control group(1558.10±410.31ng/ml)(P < 0.01),but there was no difference between the two groups,and AF group was also higher than the control group(P < 0.05).Conclusions:1.The plasma NT-probNP was significantly increased in patients with atrial fibrillation,and the plasma NT-prob NP and the left atrium diameter were closely related to atrial fibrillation.2.Atrial structure remodeling in patients with atrial fibrillation is more sensitive than ventricular structure,and the atrial structure remodeling becomes more obvious with the duration of atrial fibrillation.3.Gremlin-1 may be a predictor of LAD enlargement in patients with atrial fibrillation but without heart failure. |
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