不同血压控制水平对左室心肌力学影响的随访研究  

A follow-up study on the effects of different blood pressure control levels on left ventricular myocardial mechanics

作　　者：康晓妍[1] 高旭宏 陈晓燕[1] 薛继平[1] 李帅[1] 苗俊旺 康春松[1] Kang Xiaoyan;Gao Xuhong;Chen Xiaoyan;Xue Jiping;Li Shuai;Miao Junwang;Kang Chunsong(Department of Ultrasound,Bethune Hospital Affiliated to Shanxi Medical University,Taiyuan 030032,China)

机构地区：[1]山西医科大学附属白求恩医院超声科,太原030032

出　　处：《中华超声影像学杂志》2021年第9期752-757,共6页Chinese Journal of Ultrasonography

基　　金：山西省重点研发计划项目(201903D321199)。

摘　　要：目的应用二维斑点追踪成像(2D-STI)技术评价不同血压控制水平对原发性老年高血压患者左室心肌力学的影响。方法选取2017年1-6月于山西医科大学附属白求恩医院确诊的原发性老年高血压患者315例,将其分为标准降压组和强化降压组。对于正在接受降压药物治疗的患者通过增加或减少药物,对于尚未治疗的患者开始降压治疗,在3个月内将血压调整至目标值(标准降压组血压控制在130~150/<90 mmHg,强化降压组血压控制在110~130/<80 mmHg),均随访24个月。经过24个月降压治疗后,排除降压治疗期间失访、血压未达标或图像质量差者26例,共纳入289例,其中标准降压组148例,强化降压组141例。另选取同期71例年龄性别相匹配、无心脏结构和功能异常、无心脑血管疾病的老年人群为对照组。所有受检者均在基线位和24个月时行超声心动图检查,2D-STI获得左心室整体内层、中层、外层心肌纵向应变(GLS-endo、GLS-mid、GLS-epi)。比较基线位和24个月时各组间常规超声心动图及左室应变参数。结果①基线位时标准降压组、强化降压组室间隔舒张末期厚度(IVSD)、左室后壁舒张末期厚度(LVPWD)、左室舒张末期内径(LVEDD)、左室质量指数(LVMI)、相对室壁厚度(RWT)、舒张早期二尖瓣口血流速度与舒张早期二尖瓣环运动速度比值(E/e′)大于对照组,GLS-endo、GLS-mid、GLS-epi小于对照组(均P<0.05);标准降压组与强化降压组常规超声心动图参数、应变参数差异无统计学意义(均P>0.05)。②降压治疗24个月后,标准降压组LVEDD、E/e′及强化降压组IVSD、LVPWD、LVEDD、LVMI、RWT、E/e′小于基线位,强化降压组IVSD、LVMI、RWT小于标准降压组(均P<0.05)。③降压治疗24个月后,标准降压组及强化降压组GLS-endo、GLS-mid、GLS-epi大于基线位,强化降压组GLS-endo、GLS-mid、GLS-epi大于标准降压组(均P<0.05)。结论①原发性老年高血压患者左�Objective To evaluate the effects of different blood pressure control levels on left ventricular myocardial mechanics in patients with primary elderly hypertension by using two-dimensional speckle tracking imaging(2D-STI).Methods A total of 315 elderly patients with essential hypertension diagnosed in Bethune Hospital Affiliated to Shanxi Medical University from January to June 2017 were collected and randomly divided into standard antihypertensive group and intensive antihypertensive group.The patients who were receiving antihypertensive drugs were treated with antihypertensive drugs more or less,and the patients who had not yet been treated started antihypertensive drugs therapy.The blood pressure was adjusted to the target value within 3 months(blood pressure in standard antihypertensive group was controlled at 130-150/<90 mmHg,intensive antihypertensive group was controlled at 110-130/<80 mmHg).All patients were followed up for 24 months.After 24 months of antihypertensive drugs treatment,26 cases of lost follow-up,substandard blood pressure or poor image quality were excluded,and 289 patients were included,standard antihypertensive group(n=148),intensive antihypertensive group(n=141).During the same period,71 age-matched people without essential hypertension were selected as control group.Comprehensive echocardiography were performed in all subjects at baseline and 24 months.The longitudinal strain of the inner,middle and outer layers(GLS-endo,GLS-mid,GLS-epi)of the whole left ventricle were obtained by two-dimensional speckle tracking technique.The routine echocardiographic and left ventricular strain parameters were compared at baseline and 24 months.Results①At baseline,the end-diastolic thickness of interventricular septum(IVSD),the end-diastolic thickness of left ventricular posterior wall(LVPWD),the end-diastolic diameter of left ventricle(LVEDD),the left ventricular mass index(LVMI),the relative wall thickness(RWT)and the ratio of early diastolic mitral flow velocity to early diastolic mitral annulus

关 键 词：超声心动图描记术 斑点追踪 高血压 降压 心肌力学 

分 类 号：R544.1[医药卫生—心血管疾病]