论文部分内容阅读
目的探讨原发性高血压(EH)患者动脉僵硬度与左室舒张功能的相关性。方法收集2008-10-12的EH患者作为EH组(n=51)其中1级(n=9),2级(n=26),3级(n=16),另选择健康人作为正常对照组(对照组,n=47)。分析临床特点,同时行颈动脉超声以及超声心动图,采用血管回声跟踪(e-TRACKING)技术测定双侧颈动脉的压力应变弹性系数(Ep)、血管硬化度(β)及顺应性,测定颈动脉内膜中层厚度(IMT)。同时测定心脏舒张功能,取二尖瓣血流频谱,记录二尖瓣舒张期血流频谱,记录舒张早期(E)和舒张晚期(A)血流速度峰值。采用组织速度多普勒成像技术测定二尖瓣室间隔侧和侧壁侧的舒张早期心肌运动速度(Em)和舒张晚期心肌运动速度(Am)。探讨动脉僵硬度和心室舒张功能的相关性。结果①动脉僵硬度:EH组β(10.5±3.8)与对照组(8.1±3.4)比较、Ep[EH组(146.6±57.3)比对照组(105.3±45.8)kPa、IMT[EH组(0.55±0.23)比对照组(0.37±0.11)mm]均明显增加(均P<0.01),而动脉顺应性则明显降低[EH组(0.71±0.29)比对照组(0.86±0.47)mm2/kPa,P<0.05];②左室舒张功能:与对照组比较,EH组二尖瓣血流没有统计学差异;组织多普勒成像显示,二尖瓣环Em和Em/Am明显降低[Em,EH组(8.22±2.23)比对照组(9.91±2.52)cm/s,P<0.05;Em/Am,EH组(0.72±0.23)比对照组(0.98±0.26),P<0.01];③不同血压分级之间动脉弹性,内中膜厚度与左室舒张功能指标的比较有明显差异(P<0.05);④EH患者的动脉硬化度β和压力应变弹性系数(Ep),动脉顺应性和IMT与左室舒张功能有相关关系:β与Em/Am呈中度负相关(r=-0.45,P<0.01)、Ep与Em/Am亦呈中度负相关(r=-0.49,P<0.01)、顺应性与Em/Am呈正相关(r=0.29,P<0.05);IMT与Em/Am呈负相关(r=-0.39,P<0.01)。多元回归分析显示独立影响β的因素为Em/Am、脉压和体质量指数(F=6.83,P=0.001)。结论EH组动脉僵硬度增加,舒张功能受损,动脉硬化程度与舒张功能受损程度之间有相关关系。
Objective To investigate the correlation between arterial stiffness and left ventricular diastolic function in patients with essential hypertension (EH). Methods EH patients from October 2008 to December 2008 were enrolled as EH group (n = 51), with grade 1 (n = 9), grade 2 (n = 26) and grade 3 (n = 16) Group (control group, n = 47). The clinical features were analyzed. Carotid ultrasound and echocardiography were performed at the same time. The pressure-strain elastic coefficient (Ep), vascular stiffness (β) and compliance of bilateral carotid arteries were measured by e-TRACKING. Intima-media thickness (IMT). Cardiac diastolic function was measured at the same time. The mitral flow spectrum was recorded. The mitral diastolic flow spectrum was recorded. The peak values of early diastole (E) and late diastolic flow (A) were recorded. Tissue velocity Doppler imaging was used to measure the early diastolic myocardial velocity (Em) and the late diastolic velocity (Am) at the mitral ventricular septum and lateral wall. To investigate the correlation between arterial stiffness and ventricular diastolic function. Results ① Arterial stiffness: Compared with the control group (105 ± 3.8) kPa for Ep [EH group (146.6 ± 57.3) vs IMT [0.55 ± 0.23 ± 0.47) mm2 / kPa, P <0.23) (0.37 ± 0.11) mm] in control group (all P <0.01) <0.05]. (2) Left ventricular diastolic function: There was no significant difference in mitral flow between EH group and EH group. Tissue Doppler imaging showed that mitral annulus Em and Em / Am were significantly decreased [Em, EH group (8.22 ± 2.23) vs control group (9.91 ± 2.52) cm / s, P <0.05; Em / Am, EH group (0.72 ± 0.23) vs 0.98 ± 0.26, P <0.01] Arterial elasticity, intima-media thickness and left ventricular diastolic function indicators were significantly different (P <0.05); ④EH patients with atherosclerosis β and stress strain elastic modulus (Ep), arterial compliance and IMT and left ventricular There was a negative correlation between diastolic function and diastolic function (P <0.05). There was a moderate negative correlation between β and Em / Am (r = -0.45, P <0.01) There was a positive correlation between sex and Em / Am (r = 0.29, P <0.05). There was a negative correlation between IMT and Em / Am (r = -0.39, P <0.01). Multivariate regression analysis showed that the independent factors affecting β were Em / Am, pulse pressure and body mass index (F = 6.83, P = 0.001). Conclusion EH increased arterial stiffness, impaired diastolic function, and atherosclerosis correlated with the extent of impaired diastolic function.