血压及心率的昼夜节律与高血压患者心脏结构和功能的相关性  

Correlations between circadian rhythm of blood pressure,heart rate and cardiac structure,functions in hypertensive patients

作　　者：陈舒玲[1] 李贵[1] 彭峰[1] 赵文香[1] 林金秀[1] CHEN Shu-ling;LI Gui;PENG Feng;ZHAO Wen-xiang;LIN Jin-xiu(Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian 350005, Chin)

机构地区：[1]福建医科大学附属第一医院心内科,福建福州350005

出　　处：《中华高血压杂志》2018年第6期535-540,共6页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81770309);福建省医学创新课题(2016-CX-29);福建省自然科学基金(2018Y0024)

摘　　要：目的探讨原发性高血压患者血压及心率的昼夜节律与心脏结构和功能的相关性。方法连续纳入2015年12月到2017年7月就诊于福建医科大学附属第一医院未经治疗的原发性高血压患者147例,同期正常血压者35人作为对照。所有受试者均进行动态血压监测和心脏彩超检查。分别根据血压水平、血压昼夜变化节律、心率水平、心率昼夜变化节律进行分组研究,采用方差分析和多元线性回归分析探讨动态血压及心率各指标与左心室质量指数(LVMI)、左心房内径指数(LADI)、二尖瓣口血流速度/二尖瓣环组织运动速度(E/e')的相关性。结果高血压患者按收缩压三等分分组,夜间收缩压最高的第3组其LVMI、LADI和E/e'明显高于血压较低的第1组(均P<0.05)。清晨收缩压最高的第3组其E/e'明显高于第1组和第2组,第2组的LADI高于第1组(均P<0.05)。反杓型高血压患者LVMI、LADI和E/e'明显高于杓型血压组与非杓型血压组(均P<0.05)。非杓型/反杓型心率组其LADI和E/e'明显高于超杓型心率组,杓型心率组的E/e'也明显高于超杓型心率组(均P<0.05)。多元线性回归分析显示,夜间收缩压(β=0.289,P=0.005)、夜间收缩压下降率(β=-0.275,P=0.002)与LVMI独立相关,清晨收缩压与E/e'独立相关(β=0.235,P=0.006),夜间心率下降率与LADI(β=-0.159,P=0.047)、E/e'(β=-0.245,P=0.002)独立相关。结论夜间收缩压升高及反杓型血压与左心室肥厚相关,清晨收缩压升高及非杓型/反杓型心率与左心室舒张功能相关。Objective To investigate the relationships between circadian rhythm of blood pressure,heart rate and cardiac structure,function in patients with essential hypertension. Methods One handred and forty seven patients with primary hypertension and 35 control subjects with normal blood pressure were enrolled. All subjects were monitored by ambulatory blood pressure monitoring and cardiac color Doppler. The level of blood pressure,the circadian rhythm of blood pressure,the level of heart rate,and the circadian rhythm of heart rate were studied respectively. Variance analysis and multiple linear regression analysis were used to examine the correlations between ambulatory blood pressure,heart rate indexes and left ventricular mass index（LVMI）,left atrial diameter index（LADI）,and mitral flow velocity/mitral annulus velocity（E/e’）. Results The hypertension patients were divided into three groups according to the systolic pressure. LVMI,LADI and E/e’in the third group with the highest nocturnal systolic blood pressure were significantly higher than those in the first group with lower blood pressure（all P〈0.05）.The E/e’in the third group with the highest morning systolic blood pressure was significantly higher than that in other two groups,and the LADI in the second group was higher than that in the first group（all P〈0.05）. The LVMI,LADI and E/e’in hypertension patients with reverse-dippers were significantly higher than those in the dipper and non-dipper blood pressure groups（all P〈0.05）. The LADI and E/e’in the non-dipper and reverse-dipper heart rate group were significantly higher than those in the extreme dipper heart rate group,and the E/e’in the dipper heart rate group were significantly higher than those in the extreme dipper heart rate group（all P〈0.05）.Multiple linear regression analysis showed that nocturnal systolic blood pressure（β=0.289,P=0.005）and the rate of nocturnal systolic blood pressure decline（β=-0.275,P=0.002）were independently correlated with

关 键 词：动态血压 高血压 左心室质量指数 左心房内径指数 二尖瓣口血流速度/二尖瓣环组织运动速度 

分 类 号：R544.1[医药卫生—心血管疾病]