心率变异性与平滑指数对高血压左室肥厚逆转的影响  

Effects of heart rate variability and smoothness index on the reversal of hypertensive left ventricular hypertrophy

作　　者：王宏保[1] 施青[1] 张超[1] 

机构地区：[1]同济大学附属同济医院心内科,上海200065

出　　处：《中华医学杂志》2011年第12期832-835,共4页National Medical Journal of China

摘　　要：目的 探讨心率变异性（HRV）与平滑指数（SI）对高血压左室肥厚（LVH）逆转的影响.方法 选择未经治疗的高血压病LVH患者127例,给予口服海捷亚1片/d＋美托洛尔（12.5～50 mg/次,2次/d）.观察治疗20周前后坐位血压、超声心动图[主要检测舒张期左室后壁厚度（PWT）、室间隔厚度（IVST）、左室舒张末期内径（LVDd）与左室收缩末期内径（LVDs）等并计算左室质量指数（LVMI）]、24 h动态血压监测（ABPM）[主要包括24 h平均压、白昼平均压与夜间平均压等,并计算谷峰比值（T/P）与SI]、24 h动态心电图[主要测定时域指标中的SDNN（全部正常窦性心搏间期的标准差）、RMSSD（全部窦性心搏间期差的均方根）、PNN50（相邻正常窦性心搏问期差＞50ms的心搏数占全部心搏数的百分比）和频域指标中的低频（LF）、高频（HF）及LF/HF]等相关指标的变化.结果 20周后患者坐位血压明显下降Sbp（158.7±12.1）mm Hg与（132.2±14.0）mm Hg（1 mm Hg=0.133 kPa）;Dbp（97.2±7.7）与（86.4±6.5）mm Hg,P＜0.001;超声心动图相关参数及LVMI明显下降[LVMI（128.9±32.4）g/m2与（118.4±31.1）g/m2,P＜0.01];24 h动态血压监测相关指标明显下降[24 h平均收缩压（146.2±10.1）mm Hg与（129.7±6.1）mm Hg,P＜0.001;24 h平均舒张压（93.5±5.5）mm Hg与（81.8±6.7）mm Hg,P＜0.01;白昼平均收缩压（149.5±8.7）mm Hg与（133.6±6.3）mm Hg,P＜0.001;白昼平均舒张压（94.7±5.0）mm Hg与（83.6±7.0）mm Hg,P＜0.001;夜间平均收缩压（137.2±8.7）mm Hg与（122.7±7.6）mm Hg,P＜0.001;夜间平均舒张压（86.7±6.2）mm Hg与（72.8±5.5）mm Hg,P＜0.001].治疗后收缩压与舒张压的T/P值分别为0.79和0.71,治疗后收缩压与舒张压的SI值分别为1.4±0.5和1.2±0.6.而反映HRV变化的指标中SDNN、RMSSD、PNN50与HF明显增加[SDNN（97.3±16.7）ms与（152.3±34.2）ms,P＜0.01;RMSSD（21.3±8.7）ms与（41.9±10.4）ms,P＜0.001;PNN50（Objective To investigate the relationship of reversal of hypertensive left ventricular hypertrophy （LVH） with heart rate variability （HRV） and smoothness index （SI）.Methods A total of 127 patients with untreated essential hypertension associated with LVH were enrolled to receive a 20-week treatment.The drugs included losartan potassium ＆ hydrochlorothiazide （1 tablet/day ） and metoprolol （12.5 mg- 50 mg twice daily）.The sitting systolic and diastolic blood pressures （SBP ＆ DBP）,M-mode and pulsed Doppler echocardiography,24-hour ambulatory blood pressure monitoring （ABPM） and 24-hour ambulatory ECG （Holter） were performed at pre- and post-treatment.The changes in various parameters such as echocardiography left ventricular end-systolic dimension （LVDs）,left ventricular end-diastolic dimension （LVDd） and the thickness of interventricular septum （IVST） and posterior wall （PWT） were measured.And left ventricular mass index （LVMI） and smoothness index （SI） were also examined.The evaluated parameters of ABPM were average 24-hour,daytime and nighttime SBP ＆ DBP.As to 24-hour ambulatory ECG （Holter）,the parameters were standard deviation of normal to normal intervals （SDNN）,rate mean square of the differences of successive RR intervals （ RMSSD ） ,percentage of RR intervals differing 〉50 ms （PNN50）,high frequency （HF） and low frequency （LF）.Results After a 20-week treatment,the levels of sitting blood pressure（SBP 158.72 ± 12.11 mm Hg vs 132.21 ± 14.03 mm Hg;DBP 97.20 ± 7.71 vs 86.36 ± 6.48 mm Hg,P 〈 0.001 ）,parameters of 24-hour ABPM （24-hour mean SBP146.20 ±10.11 mm Hg vs 129.68 ±6.12 mm Hg,P〈0.001;24-hour mean DBP93.45 ±5.46mm Hg vs 81.77 ±6.71 mm Hg,P 〈0.01;daytime mean SBP 149.53 ±8.67 mm Hg vs 133.60 ±6.27mm Hg,P〈0.001;daytime mean DBP 94.68 ±4.96 mm Hg vs 83.55 ±7.03 mm Hg,P〈0.001;nighttime mean SBP 137.21 ± 8.73 mm Hg vs 122.74 ± 7.58 mm Hg,P 〈 0.001;nighttime mean DBP 86.75 ±6.22 mm Hg vs 72.81

关 键 词：左心室肥厚 心率变异性 平滑指数 血管紧张素Ⅱ受体阻滞剂 

分 类 号：R541.3[医药卫生—心血管疾病]