原发性高血压患者左心房增大的相关因素分析  

Analysis of relevant factors causing left atrial enlargement in the essential hypertensive patients

作　　者：王春[1] 柏淑禹[1] 杜昌兰[1] 刘洛平[1] 

机构地区：[1]南京大学医学院附属鼓楼医院,江苏南京210008

出　　处：《中华老年心脑血管病杂志》2006年第11期727-729,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的观察左心房增大在高血压人群中的发生率，初步探讨左心房增大的独立预测因素及相关机制。方法收集我院门诊或住院的1～2级原发性高血压患者156例，测定血压、血脂、血糖等，计算体重指数，所有患者接受超声心动图及颈动脉超声检查，检测左心房内径（〉3．9cm为左心房增大），将患者分为左心房增大组（36例）及左心房正常组（120例）。计算左心室重量指数，区分有无左心室肥厚。结果23％的患者存在左心房增大，与左心房正常组比较其年龄、病程、体重指数、甘油三酯、空腹血糖、左心室重量指数水平更高，高密度脂蛋白胆固醇水平更低，呈现左心室肥厚、颈动脉内膜增厚或斑块形成、代谢综合征的比例亦显著增高。logistic回归证实，超重（体重指数〉25kg/m^2）、左心室肥厚、收缩压≥155mmHg（1mmHg=0．133kPa），代谢综合征及颈动脉内膜增厚是预测左心房增大的独立因素。结论左心房增大与超重、左心室肥厚、代谢异常及颈动脉内膜增厚密切相关，可能是高血压病程中出现其他心血管及代谢异常时的适应性反应。Objectives To observe the prevalence of left atrial（LA） enlargement in the selected essential hypertensive individuals, to explore the independent predictors of LA enlargement and potential mechanisms. Methods Aged patients with grades-1 and-2 hypertension underwent a series of examinations： clinical blood pressure, senun lipid, plasma glucose, body mass index（BMI）, and carotid ultrasonography. LA was considered enlarged when its anteropostefior diameter exceeded 3.9 cm. Left ventricular mass index （LVMI）was also calculated and based on it, left ventricular hypertrophy （LVH）was diagnosed. Metabolic syndrome （MS）was defined according to the criteria proposed by the Chinese Diabetes Society in 2004. Results 23% of the individuals were found to have LA enlargement, they were older, more frequently overweighted, had higher levels of triglycefides （TG）,fasting glucose （FG） and lower high density lipoprotein cholesterol （HDL-C）level, furthermore, they had higher prevalence of LVH, carotid intima thickening or plaque formation and MS as compared with those having normal LA. logistic multivariate analysis showed that overweight, LVH, high SBP（ ≥ 155 mm Hg） and carotid intima thickening were the independent predictors of LA enlargement. Condusions LA enlargement is mainly correlated with overweight, LVH, carotid intima-media thickening and MS. It may be an adaptive response to other cardiovascular or metabolic disorders associated with high blood pressure.

关 键 词：高血压 心房 肥大 左心室 颈动脉 代谢综合征 

分 类 号：R541.3[医药卫生—心血管疾病]