心肌作功指数评价高血压患者左心室整体功能  

Effects of myocardial performance index on assessing left ventricular function in patients with primary hypertension

作　　者：王方芳[1] 徐伟仙[1] 陈宝霞[1] 冯新恒[1] 李昭屏[1] 高炜[1] 

机构地区：[1]北京大学第三医院心内科心血管分子生物学与调节肽卫生部重点实验室分子心血管学教育部重点实验室,北京100191

出　　处：《北京大学学报（医学版）》2014年第6期863-867,共5页Journal of Peking University:Health Sciences

基　　金：中国健康促进基金会心脏代谢治疗药物研究基金;北京大学第三医院骨干基金资助~~

摘　　要：目的:探讨心肌作功指数(myocardial performance index,MPI)在评价高血压患者左心室整体功能中的价值。方法:入选130例高血压患者(HP组,年龄53.9±13.3岁)和155例健康对照者(Con组,年龄52.4±11.6岁),应用组织多普勒技术测定左心室MPI,计算公式为:MPI=(等容收缩时间+等容舒张时间)/射血时间。将高血压组根据左心室重量指数(left ventricular mass index,LVMI)分为左心室肥厚亚组(HP-肥厚亚组,LVMI男性≥115 g/m2、女性≥95 g/m2)和无左心室肥厚亚组(HP-无肥厚亚组,LVMI男性<115 g/m2、女性<95 g/m2)。结果:Con组、HP-无肥厚亚组和HP-肥厚亚组3组间MPI比较差异有统计学意义(0.72±0.23 vs.0.54±0.17 vs.0.45±0.11,P<0.001),其中HP-肥厚亚组较HP-无肥厚亚组MPI增高(P=0.046),且均高于Con组(P均<0.001)。在对照组中,MPI与年龄(r=0.369,P<0.001)、左心室舒张末内径(r=0.169,P<0.05)、二尖瓣环Sm峰速度(r=-0.211,P<0.001)和二尖瓣环Em峰速度(r=-0.383,P<0.001)具有相关性,多因素线性回归分析显示,年龄是MPI的独立预测因素(β=0.492,t=7.222,P<0.001)。在HP组中,MPI与左房面积(r=0.293,P<0.001)、室间隔厚度(r=0.453,P<0.001)、LVMI(r=0.453,P<0.001)、相对室壁厚度(r=0.458,P<0.001)呈正相关,与Sm(r=-0.414,P<0.001)、Em(r=-0.508,P<0.001)、左心室射血分数(r=-0.305,P<0.001)呈负相关,室间隔厚度(β=0.401,t=4.256,P<0.001)和Em(β=-0.365,t=-3.878,P<0.001)是HP组MPI的独立预测因素。结论:高血压患者无论是否存在左心室肥厚,MPI均显著升高,而在左心室肥厚的患者中MPI的升高更为显著。组织多普勒成像技术测量的MPI作为综合评价心脏收缩和舒张整体功能的指标,可用于高血压患者心功能的全程监控,早期发现心功能受损患者。Objective：To investigate the value of myocardial performance index （MPI） in assessing LV function in patients with primary hypertension （HP）.Methods：We studied 130 patients with HP （mean age 54.9-± 13.3 years） and 155 healthy control subjects （mean age 52.4 ± 11.6 years）.MPI was determined by tissue doppler imaging using the following formula：MPI =（isovolumic contraction time ＋ isovolumic relaxation time）/ ejection time.The HP group was divided into hypertrophy subgroup（LVMI ≥115 g/m2 in males,or ≥95 g/m2 in females） and normal mass subgroup（LVMI ＜ 115 g/m2 in males,or ＜95 g/m2 in females）.Results：MPI was significantly different in control group,normal mass subgroup and hypertrophy subgroup（0.72 ±0.23 vs.0.54 ±0.17 vs.0.45 ±0.11,P ＜0.001）.Hypertrophy subgroup had significant higher MPI than normal mass subgroup（P =0.046）,and both the groups had significant higher MPI than control group（all P ＜0.001）.MPI was positively associated with age（r =0.369,P ＜0.001）,Left ventricular end diastolic diameter（r =0.169,P ＜ 0.05）,Sm （r =-0.211,P ＜ 0.001） and Em（r =-0.383,P ＜0.001） in control group.In multiple linear regression analysis,MPI was independently related to age （β =0.492,t =7.222,P ＜0.001） in control group.Among the HP patients,MPI was positively associated with left atrial area （r =0.293,P ＜ 0.001）,intra ventricular septum （IVS） diameter （r =0.453,P ＜ 0.001）,LVMI （r =0.453,P ＜ 0.001）,relative wall thickness （r =0.458,P ＜0.001）,and negatively associated with Sm（r =-0.414,P ＜0.001）,Em（r =-0.508,P ＜0.001）,left ventricular ejection fraction （r =-0.305,P ＜ 0.001） in bivariate analysis.In the multiple linear regression analysis,MPI was independently related to Em （β =0.401,t =4.256,P ＜0.001） and IVS diameter （β =-0.365,t =-3.878,P ＜0.001） in the HP patients.Conclusion：The HP patients had elevated MPI,especially in the ones with LV hypertrophy.Tissue doppler imaging

关 键 词：高血压 肥大 左心室 超声心动描记术 心肌作功指数 

分 类 号：R544.1[医药卫生—心血管疾病]