高血压患者左心室向心性肥厚与颈动脉僵硬度的相关性研究  

Investigation of the association between left ventricular concentric hypertrophy and carotid arterial stiffness for patients with hypertension

作　　者：高洁[1] 于明月[1] 牛慧敏[1] 

机构地区：[1]河北省人民医院超声科,河北省石家庄市050051

出　　处：《中国心血管病研究》2017年第11期1006-1011,共6页Chinese Journal of Cardiovascular Research

基　　金：河北省医学科学研究重点课题计划（项目编号：1020140206）

摘　　要：目的研究高血压患者颈动脉硬化与左心室向心性肥厚之间的相关性。方法将303例高血压患者作为研究对象，90例同龄健康自愿者作为对照组。患者进行超声心动图和颈动脉超声高分辨率回声跟踪检查。基于左心室质量指数和相对壁厚将高血压患者分成4个小组：正常几何构型组86例、向心性重构组72例、向心性肥厚组93例和偏心肥厚组52例。基于B硬化度、杨氏弹性模量、动脉动脉顺应性、单点脉搏波速度和波反射增强指数对患者左心室内中膜复合体壁厚度和动脉硬化度进行评估。结果单变量分析结果显示，B硬化度〉8．4、杨氏弹性模量Ep〉136kPa、局部单点脉搏波速度-β〉7．1m／s、增加指数AI〉21．9％、收缩压〉151mmHg、脉压〉54mmHg、IMT〉0．56mm及糖尿病与向心性肥厚显著相关。多变量分析结果显示，只有增加指数AI（OR=3．64，P=0．04）、局部单点脉搏波速度-β（OR=2．82，P=0．013）、收缩压（OR=3．11，P=0．036）及糖尿病（OR=3．73，P=0．007）与患者向心性肥厚独立相关。结论高血压患者左心室向心性肥厚与颈动脉硬化及波反射增强指数显著相关，而与收缩压和糖尿病独立相关。Objective To investigate the association between left ventricular concentric hypertrophy and carotid arterial stiffness for patients with hypertension. Methods A retrospective study involved 303 patients with hypertension, and 90 age-matched normal controls. The subjects were examined by echoeardiography and carotid ultrasound with a high-resolution echo-tracking system. Based on the left ventricular mass index（LVMI） and rela- tive wall thickness （RWT）, the patients with hypertension were divided into four patterns of LVH and geometry： normal geometry（N, n=86）, concentric remodeling（CR, n=72）, concentric hypertrophy CH（n=93） and eccentric hypertrophy（EH, n=52）. Intima-media thickness（IMT） and the parameters of arterial stiffness were also assessed using the β stiffness index（β）, Young elastic modulus（Ep）, arterial compliance（AC ）, one-point pulse wave ve- locity（PWVβ ） and the wave reflection augmentation index（AI ）. Results Univariate analysis showed that the fol- lowing variables were significant in determining CH： β〉8.4, Ep〉136 kPa, PWVβ〉7.1 m/s, AI〉21.9%, systolic BP〉151 mm Hg, PP〉54 mm Hg, IMT〉0.56 mm and the presence of diabetes. However, by multivariate analysis only AI（OR=3.64, P=0.004）, PWVβ〉7.1 m/s（ OR =2.82, P=0.013 ）, systolic BP（ OR =3.11, P=0.036 ） and the presence of diabetes（OR=3.73, P=0.007） were associated independently with the occurrence of CH. Conclusion Concentric hypertrophy in hypertension is strongly associated with carotid arterial stiffness and wave reflection pa- rameters, independently of the influence of systolic blood pressure and diabetes.

关 键 词：高血压 左心室向心性肥厚 动脉硬化 

分 类 号：R544.1[医药卫生—心血管疾病]