原发性高血压伴左心室收缩功能障碍患者左心室逆重构的发生率及预测因素分析  

Prevalence and Predictor Analysis of Left Ventricular Reverse Remodeling in Patients With Primary Hypertension Combining Left Ventricular Systolic Dysfunction

作　　者：黄燕[1] 巫雪飞 邹长虹[1] 周琼[1] 张宇辉[1] 吕蓉[1] 张健[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心力衰竭监护病房,北京市100037 [2]北京水利医院内科

出　　处：《中国循环杂志》2014年第12期987-991,共5页Chinese Circulation Journal

基　　金：国家"十二.五"科技支撑计划项目(2011BAI11B02);首都医学科学发展基金项目(20091005)

摘　　要：目的：分析标准抗心力衰竭药物治疗下原发性高血压伴左心室收缩功能障碍（高心病）患者左心室逆重构（LVRR）的发生率及其预测因素。方法：入选2008-10至2012-10在阜外心血管病医院心力衰竭病房住院治疗且入院时超声心动图检查左心室射血分数（LVEF）≤40%的高心病患者118例,收集患者首次入院时的人口学资料及临床和超声心动图指标,出院后随访至2013-12或全因死亡或心脏移植,根据复查超声心动图结果,LVRR定义为同时满足以下两个条件：1 LVEF较基线绝对值提高至少10%且随访LVEF≥50%;2左心室舒张末期内径（LVEDD）较基线相对值降低至少10%且随访LVEDD指数≤27 mm/m2,调查LVRR的发生率,探索基线预测指标。结果：平均随访（23±15）个月,39例患者（33.1%）达到LVRR标准（达到LVRR组）,其LVEF由基线的（30.6±6.8）%明显提高至随访时（57.0±4.9）%（P〈0.01）,LVEDD指数从基线的（31.6±3.9）mm/m2明显降低至随访时（24.4±1.9）mm/m2（P〈0.01）,差异均有统计学意义。达到LVRR时间平均为（11±9）个月（1-36个月）,其中27例（69.2%）患者在随访12个月内达到LVRR。79例未达到LVRR的患者（未达到LVRR组）的LVEF也从基线时（28.6±6.1）%明显提高至末次随访时（39.0±13.2）%,LVEDD指数从（38.1±5.6）mm/m2缩小至（36.1±6.9）mm/m2。多变量Logistic回归分析结果显示,心力衰竭症状病史短（〉6个月vs≤6个月,OR=0.244,P〈0.01）、心电图ORS间期短（≥120 ms vs〈120 ms,OR=0.276,P〈0.05）及入院收缩压与LVEDD指数比值的四分位越高（OR=2.724,P〈0.01）是高心病患者达到LVRR的独立预测因素。结论：经过标准抗心力衰竭药物治疗,约1/3的高心病患者可以达到LVRR,表现为LVEF恢复正常伴LVEDD明显缩小。心力衰竭病史越短、心电图QRS间期越短、基线收缩压/LVEDD指数的比值越高,达到LVRR的可能性越大。Objective： To analyze the prevalence and predictor for left ventricular reverse remodeling（LVRR） in patients of primary hypertension combining left ventricular systolic dysfunction（LVSD） with tailored medication.Methods： A total of 118 consecutive patients admitted in our unit from 2010-08 to 2012-10 with the base line left ventricular ejection fraction（LVEF） ≤ 40% were enrolled. The demographic and clinical information with the findings of echocardiography at admission were collected. The patients were followed-up until 2013-12 or until the all cause death/cardiac transplantation. According to echocardiography, LVRR was defined by 2 criteria at the same time： 1 the absolute elevation of LVEF ≥10% than base line and the follow-up LVEF ≥ 50%, 2 the relative reduction of left ventricular end-diastolic diameter（LVEDD） index ≥10% than base line and the follow-up LVEDD index ≤ 27 mm/m2. LVRR prevalence with its base line predictor was investigated.Results： The overall mean follow-up time was（23 ± 15） months, and 39/118（33.1%） patients acquired LVRR as LVEF from the base line level（30.6 ± 6.8）% increased to the follow-up level（57.0 ± 4.9）%; LVEDD index from the base line level（31.6 ± 3.9） mm/m2 decreased to the follow-up level（24.4 ± 1.9） mm/m2, all P0.01. The average time length for reaching LVRR was（11 ± 9） months, and 27/39（69.2%） patients reached LVRR within 12 months. There were 79 patients not reached to LVRR, while their LVEF also from the base line level（28.6 ± 6.1）% increased to the follow-up level（39.0 ± 13.2）%; LVEDD index from the base line level（38.1 ± 5.6） mm/m2 decreased to the follow-up level（36.1 ± 6.9） mm/m2. Multivariable logistic regression analysis indicated that the patients with the shorter duration of heart failure（HF） as 6 months vs ≤ 6 months（OR=0.244, P0.01）, shorter QRS interval as ≥ 120 ms vs 120ms（OR=0.276, P0.05） and the higher quartile of systolic blood pressure（SBP）/LVEDD inde

关 键 词：左心室逆重构 高血压 左心室收缩功能障碍 发生率 预测因素 药物治疗 

分 类 号：R54[医药卫生—心血管疾病]