高血压并代谢综合征左室重构特点临床研究

Clinic research of remodelling of left ventricle in essential hypertension patients with metabolic syndrome

目的观察高血压并代谢综合征患者左室重构的发生情况及其特点。方法选择原发性高血压并代谢综合征(HMS)患者42例,原发性高血压(EH)患者56例和对照组30例。采用多普勒超声心动图测量左室舒张末期左室内径(LVDd),舒张末期左室后壁厚度(LVPWT),舒张末期室间隔厚度(IVST),并计算左心室重量指数及左室相对厚度。同时对入选者检测空腹血糖(FSG)和血胰岛素,计算胰岛素敏感指数(ISI)。结果EH组和HMS组LVPWT、IVST、LVMI明显高于对照组(P<0.01),HMS组明显高于EH组,且RLVT与EH组比较有显著性差异(P<0.01)。HMS组血浆胰岛素(FSI)显著高于其余2组(P<0.01),而ISI显著低于其余2组(P<0.01)。结论原发性高血压并代谢综合征患者其左室肥厚程度更严重于单纯高血压病患者,且向心性肥厚明显;胰岛素抵抗和高胰岛素血症是引起左室肥厚的重要危险因素。

[Objective] To observe the development and characteristic of remodelling of the left ventricle in the essential hypertension patients with metabolic syndrome （HMS）. [Methods] 42 EH patients with metabolic syndrome, 56 EH patients and 30 controls were observed. Doppler echocardiography was applied to measure the left ventr/eular end diastolic dimension （LVDd）, left ventricu]ar posterior wall thickness （LVPWT） and interventrieular septal thickness （IVST）. The left ventr/cular mass index （LVMI） and relative thickness was calculated after Doppler and insulin sensitivity index （ISI） was calculated after fasting serum glucose （FSG） and fasting serum insulin （FSI） was detected. [Result] LVPWT, IVST, LVMI in EH patients and HMS patients was obviously higher than that in the controls （P 〈0.01）. LVPWT, IVST, LVMI in HMS patients was obviously higher than that in EH patients. There was significant difference in RLVT between HMS patients and EH patients （P 〈0.01）. FSI in HMS patients was significantly higher than that in EH patients and controls （P 〈0.01）, but ISI was significantly lower （P 〈0.01）. [Conclusions] The degree of the left ventricular thickness in EH patients with metabolic syndrome was more severe than that in EH patients and its characteristic was concentric hypertrophy. Insulin resistance and hyperinsulinemia were important risk factors which caused the left ventricle thicker.