醛固酮与高血压病左室舒张功能关系的定量研究

Correlation between aldosterone and left ventricular diastolic function in patients with essential hypertension

目的:探讨高血压病患者血清醛固酮(aldosterone,ALD)水平对左室肥厚(leftventricularhypertension熏LVH)和左室舒张功能异常的影响。方法:高血压病组55例,分为2个亚组,其中不合并LVH者(EH鄄A组)29例,合并LVH者(EH鄄B组)26例,对照组30例,均采集肘静脉自凝血,用放射免疫法测定血清ALD水平,超声心动图技术测定左室质量指数(leftventricularmassindex熏LVMI)、二尖瓣血流频谱舒张早期峰值充盈速度与舒张晚期峰值充盈速度比值(E/A),声学定量技术测定左室峰值快速充盈率与峰值心房充盈率比值(PRFR/PAFR)。结果:EH鄄A组和EH鄄B组ALD、LVMI测值明显高于对照组,其中EH鄄B组升高尤为明显(P均<0.05),而E/A、PRFR/PAFR测值明显低于对照组(P均<0.05)。高血压病组ALD与LVMI、E/A、PRFR/PAFR间均呈显著相关(r分别为0.50、-0.48、0.37,P均<0.05)。结论:血清ALD升高与高血压病LVH及舒张功能减退相关,提示ALD在高血压病LVH和左室舒张功能障碍的发生发展中起着重要作用。

Objective: To explore the effects of aldosterone (ALD) on the left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD) in patients with essential hypertension (EH). Methods: Fifty-five patients with EH were defined as EH group and 30 normal subjects as control group. EH group was further divided into two sub-groups: those without LVH as EH-A group, and those with LVH as EH-B group. The serum ALD level was measured using radioimmunological method. The left ventricular mass index (LVMI) was determined with two-dimensional echocardiography, and the peak E-wave velocity versus peak A-wave velocity (E/A ratio) was obtained from the transmitral valve inflow velocity curve with pulsed-Doppler wave imaging. The ratio of peak rapid filling rate (PRFR) versus peak atrial filling rate (PAFR) was measured with acoustic quantification (AQ) technique. Results: The serum ALD level in EH-B group was higher than that in EH-A group (268.29±88.51 vs 177.89±67.86, P<0.05), while both E/A ratio and PRFR/PAFR ratio were lower in EH-B group than those in EH-A group (0.88±0.62 vs 1.10±0.46, 1.20±0.68 vs 1.49±0.51, both P<0.05). Compared with control group, both EH-A group and EH-B group had higher ALD levels and lower E/A and PRFR/PAFR ratios (all P<0.05). Within the whole EH group, the ALD level correlated significantly with LVMI, E/A ratio and PRFR/PAFR ratio (r=0.50, -0.48, -0.37, respectively, all P<0.05). Conclusion: There are significant correlations between the serum ALD and LVMI, E/A ratio and PRFR/PAFR ratio. The increased serum ALD level may be involved in the occurrence and development of LVH and LVDD in patients with EH.