高血压患者左心房功能与血压分级的相关性  

Correlation between left atrial function and blood pressure classification in patients with hypertension

作　　者：游钫 陈新云[1] 冯雪涛[1] 薛鸿[1] YOU Fang;CHEN Xinyun;FENG Xuetao;XUE Hong(Department of Cardiology,Chengdu First People's Hospital,Chengdu,Sichuan 61004l,China)

机构地区：[1]成都市第一人民医院心功能室,四川成都610041

出　　处：《中华高血压杂志》2023年第11期1064-1070,共7页Chinese Journal of Hypertension

基　　金：成都市医学科研课题(2022316);成都市中医药大学杏林学者学科人才科研提升计划(YYZX2021123)。

摘　　要：目的 观察不同血压分级人群心脏左心房形态及功能特点,分析血压对左心房功能的影响。方法 选取2019年1月1日至2022年3月31日于成都市第一人民医院首次发现血压异常的体检人员及心内科就诊患者382例,设立正常血压组57名,正常高值血压组118名,轻度高血压组(1级高血压水平)109例,中重度高血压组(2、3级高血压水平)98例。收集人群一般资料及超声常规数据,应用实时三维超声心动图(RT-3DE)、二维斑点追踪技术(2D-STE)获取左心房相关参数,包括容积指数(LAVI)、左心房储备功能参数(LASRs)、左心房通道功能参数应变率(LASRe)、左心房助力泵功能参数(LASRa)、心房充盈分数(AFF)、左心房主动射血分数(LAAEF)、左心房被动射血分数(LAPEF),左心房机械离散度(MD),评估左心房形态及功能特点,进行不同组别间对比分析。再建立线性回归分析,排除年龄、性别、体表面积(BSA)等混杂因素,评价血压水平对左心房功能的影响。结果 从正常血压组至中重度高血压组左心房通道功能及储备功能逐步降低[LASRe:(2.9±0.7)比(2.4±0.7)比(2.0±0.5)比(1.7±0.6)s^(-1),F=55.095,P<0.001;LASRs:(4.5±0.9)比(4.1±0.8)比(3.6±0.7)比(3.2±0.8)s^(-1),F=39.762,P<0.001]。从正常血压组至轻度高血压组助力泵功能逐步升高,在中重度高血压组,助力泵功能减低。4组间MD的差异有统计学意义(Z=48.232,P<0.001)。校正年龄、性别、体表面积后,线性回归分析显示,左心房功能参数LAAEF、AFF、LASRe、LASRs在正常高值血压时期即发生改变(P<0.05)。结论 左心房功能对血压变化非常敏感,正常高值血压水平时期已存在功能变化。Objective To observe the morphological and functional characteristics of the left atrium in people with different blood pressure grades, and analyze the impact of blood pressure on left atrium function. Methods A total of 382 patients who were first diagnosed with abnormal blood pressure in the cardiology department of Chengdu First People's Hospital from January 1, 2019 to March 31, 2022 were selected, 57 patients were enrolled in the normal blood pressure group, 118 in the high-normal value of blood pressure group, 109 in the mild hypertension group(grade one hypertension level) and 98 in the moderate to severe hypertension group(grade two or three hypertension level). The general data and routine ultrasound data of the population were collected. Real-time three-dimensional echocardiography(RT-3DE) and Two-dimensional spot tracking technology(2D-STE) were used to obtain relevant parameters of the left atrium, including left atrial volume index(LAVI), left atrial peak positive strain rater(LASRs), left atrial peak early negative strain rate(LASRe), left atrial peak late negative strain rate(LASRa), left atrial filling fraction(AFF), left atrial active ejection fraction(LAAEF), left atrial passive ejection fraction(LAPEF), left atrial mechanical dispersion(MD). The morphological and functional characteristics of the left atrium were evaluated, and then comparative analysis among different groups was conducted. A linear regression analysis was developed to assess the effect of blood pressure level on left atrial function after excluding confounding factors of age, gender, and body surface area(BSA). Results From the normal blood pressure group to the moderate to severe hypertension group, the left atrial channel function and reserve function decreased gradually [LASRe:(2.9±0.7) vs(2.4±0.7) vs(2.0±0.5) vs(1.7±0.6) s^(-1), F=55.095, P<0.001;LASRs:(4.5±0.9) vs(4.1±0.8) vs(3.6±0.7) vs(3.2±0.8) s^(-1), F=39.762, P<0.001]. The pump function increased gradually from the high-normal value of blood pressure group t

关 键 词：实时三维超声 斑点追踪技术 高血压 正常高值血压 左心房功能 

分 类 号：R544.1[医药卫生—心血管疾病]