原发性高血压患者心脏重构与房室性心律失常的相关性研究  

Study on relationship between cardiac remodeling and occurrence of atrial or ventricular arrhythmias in essential hypertensive patients

作　　者：林文辉[1] 陈君柱[2] 

机构地区：[1]温州医学院附属温岭医院心血管内科,浙江省温岭市317500 [2]浙江大学医学院附属第一医院心血管内科

出　　处：《中国综合临床》2008年第2期133-135,共3页Clinical Medicine of China

摘　　要：目的探讨原发性高血压患者心脏重构对房、室性心律失常发生及其严重程度的影响。方法入选原发性高血压患者130例，均经超声心动图检查左房内径（LAD）、左室质量指数（LVMI）；24h动态心电图检查判定心律失常；用放射免疫法测定血清Ⅲ型前胶原（PCⅢ）浓度。结果①130例中检出左心房扩大87例（65．5％），左心室重构67例（51．5％），差异有统计学意义（P〈0．05）；房性心律失常91例（70．0％），室性心律失常72例（55．4％）差异亦有统计学意义（P〈0．05）。②不管是房性心律失常、复杂房性心律失常，还是室性心律失常、复杂室性心律失常，它们在心脏重构组的发生率均显著高于正常房室构型组（P〈0．05）。③LAD、LVMI和血清PCⅢ均在房、室性心律失常分级各级别间差异有统计学意义（均P〈0．05）。结论原发性高血压患者房性心律失常多于室性心律失常，此与左心房扩大多于左心室重构有关，心脏重构对高血压患者发生房、室性心律失常起重要作用，心肌细胞肥大和心肌纤维化越严重越易发生复杂房、室性心律失常。Objective To investigate the effect of essential hypertensive cardiac remodeling on the onset and severity of atrial or ventricular arrhythmias. Methods 130 essential hypertensive patients were enrolled in this study. Their left atrial dimension（LAD） and left ventricular mass index（LVMI） were measured by echocardiograph, and their arrhyttunias were monitored by 24-hour ambulatory electrocardiogram, and while seram procollagen typem Ⅲ PC Ⅲ ） was measured by radioimmunoassay. Results Of 130 essential hypertensive patients, 87 （ 65.5% ） cases were determined with left atrial enlargement and 67（51.5% ） cases with left ventficular remodeling（ P 〈 0.05） ,91 （70.0%）cases were determined with Atrial arrhythmia and 72（55.4% ） cases with ventficular arrhythmia（ P 〈 0. 05）. Morbidities of atrial, complex atrial arrhythmia and ventricular, complex ventricular arrhythmias in cardiac re- modeling group were significantly higher than there in normal geometric pattern group （ P 〈 0.05 ）, The levels of LAD, LVMI and serum PC m were significantly different among different grades of atrial or ventricular arrhythmias（ P 〈 0.05 ）. Conclusion Morbidity of atrial arrhythmia is higher than that of ventricular arrhythmia, which is correlated to the fact that morbidity of left atrial enlargement is higher than that of left ventricnlar remodeling in essential hypertensive patients;An essential role in the onset of atrial and ventricnlar arrhythmias is cardiac remodeling, and the severer myocardial cell hypertrophy and myocardial fibrosis show,the easier complex atrial and ventricnlar arrhyhmias occur in essential hypertensive patients.

关 键 词：原发性高血压 心脏重构 心律失常 心肌纤维化 

分 类 号：R544.1[医药卫生—心血管疾病]