肥胖和高血压与左心房增大关联度的比较研究

Impact of obesity and hypertension on left atrium size

目的探讨高血压、肥胖对左心房大小的影响。方法按是否患高血压或肥胖将383例受试者分为非高血压非肥胖组（Ns组，n=95）、单纯高血压组（HT组，n=97）、单纯肥胖组（OB组，n=98）及高血压合并肥胖组（HT＋OB组，n=93），比较4组临床资料、超声心动图指标及左心房大小。结果（1）4组左心房容积指数（LAVI）由高到低分别是：HT＋OB组（28．07±6．63）ml／m〉OB组（24．61±4．89）ml／m〉HT组（22．73±5．16）ml／m〉NS组（19．18±4．82）ml／m（P〈0．05）；校正年龄、性别、心率、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇后：4组之间LAVI比较仍有显著性差异（P〈0．05）。（2）Pearson相关分析表明，体质指数（BMI）与LAVI相关性明显大于收缩压、舒张压（r值分别为0．505、0．240、0．209，P〈0．001），校正其他影响因素后，BMI与LAVI之间仍有显著相关性（p=0．411，P〈0．001），而收缩压、舒张压与之无显著相关；BMI每增加1个单位，左心房内径增加0．052cm，左心房容积增加1．053ml，LAVI增加0．710ml／m。结论肥胖较高血压引起左心房增大更加明显，肥胖和高血压对左心房增大有协同作用。

Objective To investigate the impact of obesity and hypertension on the size of the left atrium. Methods A total of 383 subjects were divided into normal group （NS, n = 95）, hypertension group （ HT,n = 97 ）, obesity group （ OB, n = 98 ） and hypertension with obesity group （ HT ＋ OB, n = 93 ）. Clinical information, echocardiographic parameters and left atrial size in the four groups were compared. Results （ 1 ） The left atrial volume index （LAVI） was arranged in the order： HT ＋ OB 〉 OB 〉 HT 〉 NS（28.07 ± 6. 63 〉 24. 61 ± 4. 89 〉 22. 73 ± 5.16 〉 19. 18 ± 4. 82 ml/m, P 〈 0. 05 ） ; Difference on LAVI was significant in four groups after adjusting for age, gender, HR, FPG, TC, TG and HDL （ P 〈 0. 05 ）. （2） Pearson correlation analysis showed closer correlation between BMI with LAVI compared to SBP and DBP with LAVI （r values ： 0. 505, 0. 240, 0. 209, P 〈 0. 001 ）. After adjusting for other factors, the correlation between BMI and LAVI remains significant （13 = 0.411, P 〈 0.001 ） while no significant relationship between SBP, DBP and LAVI was found. One unit BMI increase is associated with 0. 052 cm enlargement of left atrial diameter（ LAD）, 1. 053 ml increase of left atrial volume（LAV） and 0. 710 ml/m increase of LAVI. Conclusion The impact of obesity on the size of left atrium is greater than that of hypertenstion. Obesity and hypertension have synergistic effects on enlarging left atria.