围绝经期女性高血压患者心脏结构、功能和血管功能状况及影响因素  

The characteristics of cardiac structure and function and vascular function among perimenopausal women with hypertension

作　　者：石红霞[1] 马月玲 尹璐[1] 韩树珍 余静[1] SHI Hong-xia;MA Yue-ling;YIN Lu;Han Shu-zhen;YU Jing(Health Management Center ,Second Hospital of Lanzhou University ,Lanzhou Gansu 730000,China)

机构地区：[1]兰州大学第二医院心内科,甘肃兰州730000 [2]兰州大学公共卫生学院劳动卫生与环境卫生研究所

出　　处：《中华高血压杂志》2019年第6期543-549,共7页Chinese Journal of Hypertension

基　　金：国家自然科学基金项目(81670385);甘肃卫生行业(GSWSKY2017-02)

摘　　要：目的探讨围绝经期女性高血压患者的心血管结构功能特点及其影响因素。方法选取兰州大学第二医院2016年10月-2017年10月体检的45~60岁围绝经期女性高血压患者355例为病例组,并按年龄以1∶1匹配同一来源人群中的355名围绝经期正常血压女性为对照组。对所有研究对象进行问卷调查、体格检查、血脂测定,同时测定心脏结构、功能及血管功能。结果在心脏结构方面,高血压组左心房前后径[(31.11±3.37)比(28.91±2.45)mm]、左心室舒张末前后径[(40.46±2.40)比(39.23±2.78)mm]、左心室收缩末前后径[(28.62±4.40)比(26.92±3.02)mm]、右心室前后径[(26.01±1.72)比(25.11±3.42)mm]及左心室后壁厚度[(10.23±1.22)比(9.32±0.86)mm]大于对照组(均P<0.05)。在心脏功能方面,高血压组左心房最大容积指数[(20.61±3.10)比(19.61±2.56)mL/m^2]、多普勒超声[脉冲多普勒超声二尖瓣舒张早期血流速度峰值(E)与组织多普勒超声二尖瓣环舒张早期运动速度峰值(e')的比值(E/e'):(8.08±1.34)比(7.46±1.18)、间隔e':(8.11±1.70)比(9.00±1.75)cm/s、侧壁e':(10.46±2.43)比(11.42±2.80)cm/s]与对照组的差异有统计学意义(均P<0.05)。在血管功能方面,高血压组右侧心踝血管指数(8.28±1.10比7.54±1.03)、左侧心踝血管指数(8.16±1.19比7.48±1.02)和右侧踝臂血压指数(1.20±0.11比1.18±0.11)高于对照组(均P<0.05)。多元线性回归分析发现,血压可影响围绝经期妇女心血管结构及功能,围绝经期女性高血压患者心脏结构主要受体质量指数(BMI)的影响,心脏功能主要受年龄、文化程度、绝经及腰臀比的影响,而血管功能主要受年龄和绝经的影响。结论围绝经期女性高血压患者主要出现左心室肥厚和扩大、右心室增大、左心室舒张功能及动脉硬化增加,这些不仅与高血压有关系,而且还可能受年龄增长、文化程度、绝经及肥胖等因素的影响。Objective To explore the characteristics of cardiac structure and function, vascular function and their influencing factors among perimenopausal women with hypertension. Methods The 1∶1 matched case-control study was designed. A total of 355 perimenopausal women with hypertension aged 45-60 years and 355 perimenopausal women without hypertension matched by age were enrolled in this study. Questionnaire survey, physical examination and blood lipid test were performed for all subjects. Cardiac structure and function as well as vascular sclerosis were measured. Results For cardiac structure indicators:left atrial diameter(LAd) [(31.11±3.37) vs(28.91±2.45)mm, P<0.05], left ventricular end-diastolic diameter(LVEDd) [(40.46±2.40) vs(39.23±2.78)mm, P<0.05], left ventricular end-systolic diameter(LVESd) [(28.62±4.40) vs(26.92±3.02)mm, P<0.05], right ventricular diameter(RVd) [(26.01±1.72) vs(25.11±3.42)mm, P<0.05] and left ventricular posterior wall thickness(LVPWT) [(10.23±1.22) vs(9.32±0.86)mm, P<0.05] in perimenopausal women with hypertension were higher than those in perimenopausal without hypertension. For cardiac function indicators, there were significant differences in left ventricular ejection fraction(LVEF)[(20.61±3.10) vs(19.61±2.56) mL/m^2, P<0.05], E/e’ [(8.08±1.34) vs(7.46±1.18), P<0.05], interval e’ [(8.11±1.70) vs(9.00±1.75)cm/s, P<0.05] and lateral e’ [(10.46±2.43) vs(11.42±2.80)cm/s, P<0.05] between perimenopausal female with hypertension and those without hypertension. For vascular function indicators, right cardio-ankle vascular index(CAVI-R)(8.28±1.10 vs 7.54±1.03, P<0.05), left cardio-ankle vascular index(CAVI-L)(8.16±1.19 vs 7.48±1.02, P<0.05) and right ankle-brachial blood pressure index(ABI-R)(1.20±0.11 vs 1.18±0.11, P<0.05) were significantly higher in perimenopausal women with hypertension than those in perimenopausal without hypertension(P<0.05). Among perimenopausal women with hypertension, the influence factor of cardiac structure was body mass index(BMI), the

关 键 词：围绝经期 女性 高血压 心脏 血管 

分 类 号：R544.1[医药卫生—心血管疾病]