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目的:探讨Tei指数联合组织多普勒(DTI)评价妊娠期高血压疾病患者不同左室构型左室功能的临床价值。方法:选择2013年1~10月奉化市中医医院就诊的妊娠期高血压疾病患者200例为妊娠期高血压疾病组,根据构型不同类型将妊娠期高血压疾病组分为左室正常构型组(Ⅰ组=51例)、左室向心性重构组(Ⅱ组=57例)、左室向心性肥厚组(Ⅲ组=46例)、左室离心性肥厚组(Ⅳ组=46例)。选择同期血压正常的妊娠妇女50例为对照组。测量室间隔(IVS)、左室后壁厚度(LVPW)及左室舒张末内径(LVDd),并记录左室射血分数(EF)和短轴缩短率(FS)、二尖瓣血流频谱图舒张早期与舒张晚期血流峰值比(E/A)、左室Tei指数,组织多普勒测二尖瓣前叶瓣环运动频谱图收缩期运动幅度S峰及舒张早期与舒张晚期峰速比(Ea/Aa)。结果:①妊娠期高血压疾病组内各不同左室构型亚组收缩压及舒张压均较对照组显著增高,差异均有高度统计学意义(P<0.01);但妊娠期高血压疾病组内各不同左室构型亚组患者血压间差异无统计学意义(P>0.05)。②Ⅰ、Ⅱ组患者的LVMI水平与对照组比较差异无统计学意义(P>0.05);Ⅲ、Ⅳ组LVMI水平高于Ⅰ、Ⅱ组,差异有统计学意义(P<0.05),但Ⅲ、Ⅳ组间LVMI水平比较差异无统计学意义(P>0.05);Ⅰ、Ⅱ、Ⅲ组E/A值均低于对照组及Ⅳ组,差异有统计学意义(P<0.05)。不同左室构型亚组S值呈递减趋势,其中Ⅱ、Ⅲ、Ⅳ组低于对照组,差异有统计学意义(P<0.05);Ⅳ组均低于Ⅰ、Ⅱ、Ⅲ组,差异有统计学意义(P<0.05);Ⅰ、Ⅱ、Ⅲ、Ⅳ组Ea/Aa均低于对照组,差异有统计学意义(P<0.05);Tei指数各组呈递增趋势,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ组高于对照组,Ⅲ组高于Ⅰ组,Ⅳ组高于Ⅰ、Ⅱ、Ⅲ组,差异均有统计学意义(P<0.05)。Ⅳ组的EF、FS均小于Ⅰ、Ⅱ、Ⅲ组,差异均有统计学意义(P<0.05);而Ⅰ、Ⅱ、Ⅲ组与对照组间EF、FS比较差异无统计学意义(P>0.05)。③Tei指数与S值、Ea/Aa及EF之间均呈负相关(r=-0.44,-0.34,-0.47,P<0.05);Tei指数和E/A无相关性(P>0.05)。结论:Tei指数联合DTI能简便、敏感、综合评价原发性高血压患者不同左室构型的收缩和舒张功能。
Objective: To investigate the clinical value of Tei index combined with Doppler (DTI) in evaluating left ventricular function in patients with hypertensive disorder complicating pregnancy. Methods: From January to October 2013, 200 cases of hypertensive disorder complicating pregnancy in Fenghua Hospital of Traditional Chinese Medicine were treated with gestational hypertension. According to the different types of gestational hypertension, the patients with gestational hypertension were divided into normal left ventricular configuration (Ⅰ group = 51 cases), left ventricular concentric remodeling group (Ⅱ group = 57 cases), left ventricular concentric hypertrophy group (Ⅲ group = 46 cases), left ventricular eccentric hypertrophy group (Ⅳ group = 46 cases ). Select the same period of normotensive pregnant women 50 cases as the control group. The left ventricular posterior wall thickness (LVPW) and left ventricular end diastolic diameter (LVDd) were measured and the left ventricular ejection fraction (EF) and short axis shortening (FS), mitral flow spectrum In the early diastole and late diastolic blood flow peak ratio (E / A), left ventricular Tei index, tissue Doppler measured anterior mitral valve annulus motion spectrum systolic exercise amplitude S peak and early diastolic and diastolic peak velocity Ratio (Ea / Aa). Results: (1) Systolic pressure and diastolic blood pressure were significantly higher in subgroups with different left ventricular configuration in gestational hypertension group than those in control group (P <0.01); however, Within the different left ventricular configuration subgroups there was no significant difference in blood pressure (P> 0.05). (2) There was no significant difference in the level of LVMI between the two groups (P> 0.05). The level of LVMI in group Ⅲ and Ⅳ was higher than that in group Ⅰ and Ⅱ (P <0.05) There was no significant difference in LVMI between Ⅳ groups (P> 0.05). The E / A values in Ⅰ, Ⅱ and Ⅲ groups were lower than those in control group and Ⅳ group (P <0.05). The values of S in different subtypes of left ventricular configuration tended to decrease, among which, the levels in group Ⅱ, Ⅲ and Ⅳ were lower than those in control group (P <0.05); those in group Ⅳ were lower than those in groups Ⅰ, Ⅱ and Ⅲ (P <0.05). The Ea / Aa of group Ⅰ, Ⅱ, Ⅲ and Ⅳ were lower than that of control group, the difference was statistically significant (P <0.05) The levels in group Ⅲ and Ⅳ were higher than those in control group, while those in group Ⅲ were higher than those in group Ⅰ, and those in group Ⅳ were higher than those in group Ⅰ, Ⅱ and Ⅲ (all P <0.05). The EF and FS in group Ⅳ were lower than those in group Ⅰ, Ⅱ and Ⅲ (P <0.05), while there was no significant difference in EF and FS among group Ⅰ, Ⅱ and Ⅲ and control group (P> 0.05). There was a negative correlation between Tei index and S, Ea / Aa and EF (r = -0.44, -0.34, -0.47, P <0.05). There was no correlation between Tei index and E / A (P> 0.05). Conclusion: Tei index combined with DTI can be simple, sensitive and comprehensive evaluation of systolic and diastolic function of different left ventricular structures in patients with essential hypertension.