原发性高血压患者心肌能量消耗水平变化与左心室舒张功能的关系  

Relation between changes of myocardial energy expenditure and left ventricular diastolic function in primary hypertension patients

作　　者：白书昌 沈安娜[1] 王鹏[1] 谢志斌[1] 任昊[1] 许顶立[1] 

机构地区：[1]南方医科大学南方医院心内科教育部器官功能衰竭防治省部共建重点实验室,广州510515

出　　处：《中华老年心脑血管病杂志》2011年第4期340-343,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：广东省科技计划项目(2009B030801204);广东省自然科学基金(8151051501000048)

摘　　要：目的探讨左心室舒张功能障碍与舒张功能正常的原发性高血压患者心肌能量消耗(MEE)水平的不同及其临床意义。方法选取原发性高血压患者128例,分别用组织多普勒和脉冲多普勒成像技术测量左心室舒张功能指标二尖瓣环舒张早期及舒张晚期运动速度之比(E'/A')、二尖瓣口舒张早期及舒张晚期血流速度之比(E/A)以及F/F';同时测量心脏结构指标、收缩功能指标,计算左心室收缩末周向室壁应力(cESS)、MEE。根据E'/A'将患者分为Gl组(E'/A'≥1)和G2组(E'/A'<1),根据E/A分为G3组(E/A≥1)和G4组(E/A<1),根据E/E'分为G5组(E/E'≥8)和G6组(E/E'<8)。结果 G2组左心房内径、左心室内径、室间隔厚度、左心室后壁(PWTd)、左心室质量指数、cESS及MEE明显高于G1组,LVEF明显低于G1组(P<0.01);G4组年龄、PWTd明显高于G3组;G6组体重指数、短轴缩短率、LVEF明显高于G5组,左心房内径、每搏输出量及左心室射血时间、心率、cESS及MEE明显低于G5组。双变量相关分析显示,E'/A'、E/E'与cESS、MEE等各指标间均有相关关系。结论左心室舒张功能障碍的原发性高血压患者MEE水平明显高于舒张功能正常的原发性高血压患者。Objective To investigate the difference of myocardial energy expenditure（MEE） in patients with primary hypertension with and without left ventricular diastolic dysfunction and its clinical significance. Methods 128 patients with primary hypertension were recruited. The pulsed Doppler was used to measure the diastolic early maximal velocity（E） and late maximal velocity （A） of mitral flow. The structural and systolic functional parameters were measured simultaneously,and the eESS, MEE and LVMI were calculated. TDI was used to obtain the movement spectrum of mitral annulus,early（E＇） and late（A＇） diastolic maximal velocities were measured. The patients were divided into six groups according to the ratios of E＇/A＇ ,E/A and E/E＇ ：GI（E＇/A＇≥ 1） ,G2（E＇/A＇〈1） ,G3（E/A≥1） ,G4（E/A〈1） ,G5（E/E＇≥8） and G6（E/E＇〈8）. Results Group G2 had significantly higher LA, LV, IVS, PWTd, LVMI, tESS and MEE and lower LVEF com- pared with G1. Compared with G5,G6 had higher BMI, FS, LVEF and lower LA, left ventricular stroke volume and ejection time, heart rate, tESS and MEE. G4 had higher PWTd and age compared with G3. E＇/A＇ and E/E＇ showed significant correlation with cESS, MEE and LVMI, where- as E/A showed correlation with age. Conclusion The MEE level in hypertensive patients with left ventricular diastolic dysfunction is higher than that in those with normal diastolic function.

关 键 词：高血压 心室功能 左 能量代谢 超声检查 多普勒 脉冲 每搏输出量 

分 类 号：R544.1[医药卫生—心血管疾病]