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意义未明的克隆性造血与心房颤动

Clonal hematopoiesis of indeterminate potential and atrial fibrillation.

作者信息

Liu Jie, Zhang Nan, Teng Guangshuai, Tse Gary, Bai Jie, Lip Gregory Y H, Liu Tong

机构信息

Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.

Department of Hematology, Second Hospital of Tianjin Medical University, Tianjin, China.

出版信息

Heart Rhythm. 2025 May 12. doi: 10.1016/j.hrthm.2025.05.011.

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia. Clonal hematopoiesis of indeterminate potential, characterized by the clonal expansion of hematopoietic stem cells owing to acquired mutations without hematologic malignancies, has emerged as a potential risk factor for AF. This narrative review summarizes the shared risk factors between clonal hematopoiesis of indeterminate potential and AF, including age, lifestyle behaviors, and cardiometabolic conditions. It then explores the underlying mechanisms including inflammation, atrial fibrosis, and abnormal red cell distribution width. Among these, inflammation is a central driver that promotes abnormal calcium handling, which further accelerates atrial remodeling. For specific mutations, TET2 mutations correlate strongest with AF, and other mutations in genes, such as ASXL1, JAK2, TP53, and PPM1D, and spliceosomes, may also modulate AF susceptibility, although their precise roles require further investigation.

摘要

心房颤动(AF)是最常见的持续性心律失常。具有不确定潜能的克隆性造血,其特征是由于获得性突变导致造血干细胞克隆性扩增且无血液系统恶性肿瘤,已成为AF的一个潜在危险因素。这篇叙述性综述总结了具有不确定潜能的克隆性造血与AF之间的共同危险因素,包括年龄、生活方式行为和心脏代谢状况。然后探讨了潜在机制,包括炎症、心房纤维化和异常红细胞分布宽度。其中,炎症是促进异常钙处理的核心驱动因素,进而加速心房重塑。对于特定突变,TET2突变与AF的相关性最强,而其他基因如ASXL1、JAK2、TP53和PPM1D以及剪接体中的突变也可能调节AF易感性,尽管它们的确切作用需要进一步研究。

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