高血压患者心肌缺血性改变与左室后壁厚度的相关性研究  

Correlation between the ischemic change and the thickness of left ventricular posterior wall in hypertensive patients

作　　者：廖海星[1] 汤庆[1] 何文凯[2] 

机构地区：[1]广州医学院第一附属医院超声诊断科,广东广州510120 [2]广州医学院第一附属医院心血管内科,广东广州510120

出　　处：《热带医学杂志》2011年第4期450-453,共4页Journal of Tropical Medicine

摘　　要：目的探讨高血压患者Holter上心肌缺血性改变与左心室后壁(LVPW)厚度之间的相关性。方法收集2005年5月至2008年9月在本院经查冠脉CTA及超声心动图排除冠心病的高血压患者共138例,首先根据Holter上有无发作性ST段压低将资料分为有缺血性改变与无缺血性改变两组,分析缺血性改变与LVPW厚度之间的相关性,并比较两组间LVPW厚度的大小;然后以单因素及多因素分析筛选Holter上缺血性改变的影响因素;最后建立ROC曲线评估LVPW厚度预测发生缺血性改变的价值。结果高血压患者Holter上有或无缺血性改变与LVPW厚度及收缩压(SBP)均呈正相关(r=0.429,P=0.000;r=0.274,P=0.034),高血压伴有缺血性改变的患者其LVPW厚度与无缺血性改变的患者相比差异有统计学意义(z=-5.025,P=0.000);伴有LVPW增厚的高血压患者出现Holter上缺血性改变的机率高于无LVPW增厚的患者(χ2=23.670,P=0.000);多因素分析中只有LVPW厚度被筛选出来(OR=26.024,P=0.001);以LVPW厚度预测心肌缺血的AUC为(0.760±0.044),P=0.000。最佳分界值为9.5mm,以LVPW≥9.5mm来预测高血压患者Holter上出现缺血性改变,敏感性为63.6%,特异性为80.9%。结论高血压患者Holter上出现缺血性改变与LVPW厚度呈正相关;以LVPW预测高血压患者Holter上出现缺血性改变的特异性较高,但敏感性较差。Objective To analyze the correlation between the ischemic change on Holter examination and the thickness of left ventricular posterior wall （LVPW） measured by echocardiography in hypertensive patients.Methods From May 2005 to September 2008,the clinical data of 138 hospitalized hypertensive patients without the complication of coronary artery disease by the examination of cardiac computed tomographic angiography （CTA） were collected.Firstly,the data were divided into two groups with or without ischemic change according to the presence of ST segment depression on Holter examination.The correlation was analyzed between the ischemic change and the thickness of LVPW,and the mean of the thickness of LVPW was compared between the groups with or without ischemic change.Univariate and multivariate analysis were used to screen the risk factors of the ischemic change on Holter examination.The receiver operating characteristic （ROC） curves were used to evaluate the thickness of LVPW in predicting the presence of ischemic change in hypertensive patients.Results The presence of ischemic change in hypertensive patients positively correlated with the thickness of LVPW（r=0.298,P=0.009） and SBP（r=0.274,P=0.034）.The significant difference of the thickness of LVPW was found between the group with ischemic change and the group without ischemic change in hypertensive patients（z=-5.025,P=0.000）.The incidence rate of ischemic change on Holter examination was higher in the hypertensive patients with increased thickness of LVPW than that in the patients without increased thickness of LVPW（χ2=23.670,P=0.000）.The thickness of LVPW was screened out by multivariate analysis as the only risk factor for the presence of ischemic change in hypertensive patients （OR=26.024,P=0.001）.The area under cure （AUC） of the ROC curve of the thickness of LVPW in predicting the presence of ischemic change in hypertensive patients was （0.760±0.044）,P=0.000,the optimal cut-off value was 9.5mm.Thickness of LVPW ≥9.5 m

关 键 词：高血压 超声心动图 HOLTER 缺血性改变 左心室后壁 

分 类 号：R544.1[医药卫生—心血管疾病]