心电图左室高电压对高血压心肌微血管病变的诊断价值  

The diagnostic value of electrocardiographic left ventricular hypervoltage for myocardial microvascular impairment in essential hypertension

作　　者：迟东升[1] 刘伊丽[1] 王鹏[1] 刘俭[1] 陈小林[1] 查道刚[1] 谢志斌[1] 李琦[1] 冯金华[1] 修建成[1] 区文超[1] 许顶立[1] 吴平生[1] 

机构地区：[1]第一军医大学附属南方医院心内科,广州510515

出　　处：《中国综合临床》2004年第1期3-6,共4页Clinical Medicine of China

基　　金：军队"九五"重点资助项目 (98Z0 72 )

摘　　要：的　探讨心电图左室高电压对评估高血压心肌微血管病变的价值。方法　应用心肌对比超声心动图 ,静注微泡造影剂 (全氟显 )后 ,采用间断谐波成像技术测量静息时和注射双嘧达莫后心肌的A、β和A·β,并计算出A、β比值和冠脉微血管的血流储备 (CMVFR)。 结果　与对照组相比 ,高血压伴心电图左室高电压患者静息时的A、β和A·β值均增高 ;而应用双嘧达莫后左室高电压和无左室高电压组增加的幅度明显减少 ,A、β比值、β比值以及CMVFR显著降低。其中左室高电压者降低更明显 ;随着高血压病情的加重 ,A、β值逐渐增高 ,A比值、β比值和CMVFR逐渐下降 ,A、β和A·β值与RV5、SV1、RV5+SV1、SBP、DBP显著正相关 (P<0 .0 5和 0 .0 1) ,CMVFR与SV1和DBP显著负相关 (P <0 .0 1)。结论　高血压患者的静息心肌微循环血流量增加、心肌微血管储备和非内皮依赖性的血管扩张能力明显受损 ,心肌毛细血管密度明显减少 ,并且随着疾病的进展而加重 ;高血压LVH患者较无LVH者的心肌微血管功能受损程度更严重 ;高血压患者如果合并心电图左室高电压时 ,应考虑存在心肌微血管病变的可能性 ;MCE对诊断高血压微血管疾病有着良好的应用前景。Objective To evaluate the value of electrocardiographic left ventricular hypervoltage(ELVH)in diagnosis of myocardial microvascular impairment in essential hypertension(EH). Methods After intravenous injection of Quanfuxian the values of A,β and A·β in rest and after dipyridamole injection were measured by intermittent harmonic imaging with myocardial contrast echocardiography(MCE). Ratio A,Ratio β and coronary microvascular flow reserve(CMVFR) were also calculated. Results Compared with controls,the rest values of A,β and A·β in hypertensions with ELVH were higher,after dipyridamole injection,A,β,A·β,ratio A,ratio β and CMVFR were obviously lower (P<0.01) in EH patients with and without ELVH than those in controls and those with ELVH were much lower. With disease developing,A and A·β increased,and ratio A and CMVFR decreased. A,β and A·β correlated positively with Rv5,Sv1,R v5+Sv1,SBP and DBP(P<0.05 and 0.01),and CMVFR negatively correlated with S V1 and diastolic blood pressure(P<0.01). Conclusion The rest myocardial microcirculation reversely increases,and myocardial microvascular flow reserve and endothelial independent vascular relaxing ability severity in patients with EH,especially are reduced,furthermore,they are progressing with disease severity in patients with EH,especially in those with ELVH. MCE is promising in diagnosing hypertensive microvascular disease.

关 键 词：高血压 左室高电压 心肌微血管病变 

分 类 号：R541.3[医药卫生—心血管疾病]