超声心动图左心室重构指数正常参考值与原发性高血压左心室几何构型及功能研究  

Study of echocardiographic normal reference value of left ventricular remodeling index and left ventricular geometry and function in primary hypertension

作　　者：杨利华 邓燕[3] 刘玉萍[2] 帅平[2] 尹立雪 Yang Lihua;Deng Yan;Liu Yuping;Shuai Ping;Yin Lirue(Clinical Medicine Academy,Southwest Medical University,Luzhou 646000,China;Department of Health Management,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China;Department of Cardiovascular Ultrasound and Non-invasive Cardiology,Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province,Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China)

机构地区：[1]西南医科大学临床医学院,泸州646000 [2]四川省医学科学院·四川省人民医院(电子科技大学附属医院)健康管理中心,成都610072 [3]四川省医学科学院·四川省人民医院(电子科技大学附属医院)心血管超声及心功能科超声心脏电生理学与生物力学四川省重点实验室,成都610072

出　　处：《中华超声影像学杂志》2025年第3期185-193,共9页Chinese Journal of Ultrasonography

基　　金：国家重点研发计划(2020YFC2008000);深圳市医学研究专项资金(C2405001)。

摘　　要：目的:建立健康成年人左心室重构指数(RI)正常参考值,评价基于无症状原发性高血压患者RI的不同左心室几何构型表型与左心室收缩及舒张功能。方法:采用回顾性研究设计,从2012年《中国汉族正常成年人超声心动图测量值研究》多中心研究(EMINCA)中筛选906例汉族健康志愿者作为健康对照组。基于95%CI(xˉ±1.96 s)建立左心室RI正常参考值,同时对不同年龄组和性别间的差异进行统计学分析。前瞻性纳入2023年7月至2024年3月四川省人民医院健康管理中心的340例无症状原发性高血压患者作为高血压组。利用常规超声心动图和二维斑点追踪技术评估左心室结构和功能,计算左心室质量指数(LVMI)、RI、相对室壁厚度(RWT)、二尖瓣口舒张早期血流峰值速度(E)与二尖瓣环平均舒张早期运动峰值速度(e')比值(E/e')、E与二尖瓣口舒张晚期血流峰值速度(A)比值(E/A)等,比较高血压组与健康对照组间以上参数的差异。根据舒张末期左心室后壁厚度(LVPWd)和RI值将高血压组分为3个亚组:无左心室肥厚组,左心室肥厚伴正常RI组及左心室肥厚伴低RI组,分析各亚组间相关参数的差异。采用Pearson相关性分析和多元线性回归分析法评价左心室RI与GLS、LVEF、二尖瓣环平均收缩期峰值速度(s')、e'、E/e'及E/A之间的相关性。结果:健康对照组不同性别左心室RI随年龄增长均呈减低趋势,且女性左心室RI高于男性(P<0.001)。与健康对照组相比,高血压组LVMI、E/e'增高,RI、e'、s'降低(均P<0.001)。高血压组3个亚组间比较,与其他两组相比,左心室肥厚伴低RI组LVMI、E/e'增高,GLS绝对值及s'降低(均P<0.001)。Pearson相关性分析显示,左心室RI与GLS、E/e'呈负相关(r=-0.457、-0.281,均P<0.001),与LVEF、e'、s'及E/A呈正相关(r=0.229、0.394、0.150、0.172,均P<0.05)。多元线性回归分析显示,左心室RI与GLS、LVEF、e'、s'、E/e'、E/A存在独立相关性�Objective:To establish the normal reference value of the left ventricular remodeling index(RI)in healthy adults,and to evaluate the phenotypes of RI in various left ventricular geometries and its relationship with left ventricular systolic and diastolic functions in asymptomatic hypertensive patients.Methods:A retrospective study design was employed,906 healthy Han Chinese volunteers were selected as the control group from the multicenter study"Echocardiographic Measurements in Normal Chinese Adults"(EMINCA),which was conducted in 2012.The normal reference range of left ventricular RI was established based on the 95%CI(xˉ±1.96 s).Statistical analyses were conducted to evaluate differences in RI across age groups and between genders.A total of 340 asymptomatic hypertensive patients in the Department of Health Management,Sichuan Provincial People's Hospital from July 2023 to March 2024 were prospectively included as the hypertension group.Conventional echocardiography and two-dimensional speckle tracking imaging were used to assess left ventricular structure and function.Parameters such as left ventricular mass index(LVMI),RI,relative wall thickness(RWT),the ratio of early diastolic mitral inflow velocity to the average early diastolic mitral annular velocity(E/e'),and the ratio of early diastolic to late diastolic mitral inflow velocities(E/A)were calculated.Differences of these parameters between the hypertension group and the healthy control group were compared.The hypertension group was stratified into 3 subgroups based on left ventricular posterior wall thickness at end-diastole(LVPWd)and RI:the non-LV hypertrophy group,the left ventricular hypertrophy with normal RI group,and the left ventricular hypertrophy with low RI group.Relevant parameters were compared among these subgroups,and the statistical significance of the differences was analyzed.Pearson correlation analysis and multiple linear regression analysis were performed to explore the relationships between left ventricular RI and GLS,LVEF,the average

关 键 词：超声心动描记术 原发性高血压 左心室重构指数 左心室几何构型 心室功能 

分 类 号：R544.1[医药卫生—心血管疾病]