原发性高血压患者左心室舒张早期血流传播速度的变化及其临床意义  

Alteration of left ventricular early diastolic flow propagation velocity in patients with essential hypertension and its clinical significance

作　　者：王志斌 [1] 付长波 [2] 李树芳  

机构地区：[1]266003,青岛,青岛大学医学院附属医院心脏超声科 [2]266003,青岛,青岛大学医学院附属医院心血管内科 [3]山东省招远市人民医院心脏超声室

出　　处：《中华医学超声杂志（电子版）》2005年第4期211-215,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨原发性高血压患者左心室舒张早期血流传播速度(VP)变化与左心室几何构型改变之间的关系.方法对原发性高血压患者105例和健康志愿者37例,应用M型超声心动图测量左心室舒张末期内径(LVIDd)、室间隔舒张末期厚度(IVSd)、左心室后壁舒张末期厚度(LVPWd)和左心室射血分数(LVEF),并计算左心室相对室壁厚度(RWT)及左心室心肌质量指数(LVMI),采用彩色M型多普勒在心尖四腔心切面测量VP,并对超声参数行组间分析比较.结果根据LVMI和RWT的不同,将高血压患者分为左心室正常构型(35例)、向心性重构型(22例)、向心性肥厚型(28例)和离心性肥厚型(20例),高血压各组VP均较对照组减小(P＜0.05或0.01),且在正常构型、向心性重构、向心性肥厚和离心性肥厚组呈逐渐减小趋势(P＜0.05或0.01).Spearman等级相关分析显示VP与左心室几何构型变化之间存在良好相关性(r=-0.62,P＜0.01).多元线性回归分析显示,LVMI、收缩压和年龄是高血压患者VP的重要影响因素(分别r=-0.40,P=0.02;r=-0.25,P=0.04;r=-0.20,P=0.01).结论VP在原发性高血压患者均小于正常对照组,且在正常构型、向心性重构、向心性肥厚和离心性肥厚组呈依次递减趋势,准确反映了高血压左心室重构过程中舒张功能受损程度的变化.Objective To evaluate the alteration of left ventricular early diastolic flow propagation velocity （Vp） during left ventricular geometric remodeling in essential hypertension and to investigate its clinical significance. Methods This study included 105 patients with essential hypertension and 37 healthy controls. Left ventricular internal dimension at end diastole, and interventricular septal thickness at end diastole, posterior wall thickness at end diastole and left ventricular ejection fraction were measured using M-mode echocardiography. Left ventricular relative wall thickness （RWT） was calculated and left ventricular mass index （LVMI） was calculated by corrected Devereux formula. Vp was measured using color M-mode Doppler in apical four-chamber view. These uhrasonographic parameters were compared between the 2 groups. Results Based on LVMI and RWT, hypertensive patients were divided into 4 groups, i. e. , normal geometry （35 eases ）, concentric remodeling （22 cases ） , concentric hypertrophy （28 cases ） and eccentric hypertrophy （20 cases ）. Vp in each of hypertensive groups was significantly lower than in control group （ P 〈 0.05 or 0.01 ）. There was a significant step-down change among normal geometry, concentric remodeling, concentric hypertrophy and eccentric hypertrophy groups in Vp （ P 〈 0.05 or 0.01 ）, Spearman rank analysis showed there was a good correlation between VF and the progression of left ventricular geometric patterns （r = -0. 62, P 〈0.01 ）. Multiple linear regression analysis showed that LVMI, systolic blood pressure and age were important determinants of Vp in hypertensive patients （ r = - 0. 40, P = 0. 02; r = -0. 25, P=0.04; r = -0. 20, P=0.01 ; respectively）. Conclusions Vp, which decreases progressively in normal geometric, concentric remodeling, concentric hypertrophy and eccentric hypertrophy patterns in patients with essential hypertension and is significantly lower than in control group, reflects accurately the left ventricular di

关 键 词：超声心动描记术 高血压 血流速度 原发性高血压患者 左心室几何构型 血流传播速度 舒张早期 左心室舒张末期内径 临床意义 相对室壁厚度 

分 类 号：R544.1[医药卫生—心血管疾病] R540.45[医药卫生—内科学]