并或不并高血压的代谢综合征患者左室结构和功能特点

Left Ventricular Structure and Function in Patients with Metabolic Syndrome Complicated or not Complicated with Hypertension

目的探讨代谢综合征(MS)患者在并发或不并发高血压时的心脏结构和功能的特点。方法依据中国人MS诊断标准(CDS标准)和JNC7高血压诊断标准分为:MS血压正常组(NMS组)196例(男115例,女81例),MS高血压组(HMS组)153例(男97例,女56例);对照组(Control组)91例(男53例,女38例),为同期健康体检者。观察空腹血糖、血脂、胰岛素、C肽及体重指数,应用超声心动图检测左室结构和功能。结果与对照组相比,代谢综合征组糖、脂代谢异常(P<0.05),尤其以HMS组更为明显;3组之间收缩末期左室内径(LVESD)(HMS:31.5±7.2比NMS:28.4±7.7比control:28.1±7.0)mm、舒张末期室间隔厚度(IVSTd)(HMS:11.7±1.6比NMS:11.2±2.0比control:10.6±2.1)mm、舒张末期左室后壁厚度(LVPWTd)(HMS:10.9±1.8比NMS:10.4±1.9比control:9.0±1.7)mm、左室壁相对厚度(RWT)(HMS:0.48±0.09比NMS:0.46±0.11比control:0.41±0.08)、左室质量(LVM)(HMS:202.6±58.5比NMS:190.8±50.9比control:163.8±49.5)g及左室质量指数(LVMI)(HMS:123.3±40.6比NMS:109.9±32.8比control:103.1±31.6)g/m2有明显的差异,HMS组明显高于其他两组(P<0.01);3组之间E值(HMS:0.6±0.2比NMS:0.7±0.2比control:1.0±0.2)及E/A值(HMS:0.8±0.2比NMS:1.0±0.8比control:1.3±0.5)有明显的差别,HMS组下降的更明显(P<0.05);与对照组、NMS组相比,HMS组的FS及LVEF下降,与对照组之间的差异有显著性(FS:HMS:42.1±9.8比control:34.7±11.3;LVEF:HMS:54.8±13.4比control:64.4±11.5,P<0.01)。结论代谢综合征患者即使没有高血压时已有左室结构及功能明显受损,随血压水平的升高,这些改变更为明显。

Objective To study the characterstics of left ventricular structure and function in patients with metabolic syndrome. Methods Patients including 196 patients with normotensive metabolic syndrome （NMS）, 153 patients with hypertensive metabolic syndrome （HMS） and 91 normal persons were enrolled using the JNC 7 criteria. Fasting plasma glucose, fasting plasma lipid, fasting insulin, C-peptide and body mass index were determined, left ventricular configuration and function by means of echocardiography were assessed. Results Compared with normal subjects, HMS and NHS had greater LVESD （ HMS：31.5± 7.2 vs NMS： 28.4 ± 7.7 vs control： 28. 1± 7.0 mm）, IVSTd（ HMS： 11.7 ± 1.6 vs NMS： 11.2±2.0 vs control：10. 6±2. 1 mm）, LVPWTd（HMS：10.9±1.8 vs NMS：10.4±1.9 vs control：9.0±1.7 mm）, RWT[HMS：0.48±0.09 vs NMS：0.46±0. 11 vs control：0.41＋0.08）, LVM（HMS：202.6± 58. 5 vs NMS：190. 8±50.9 vs control：163.8±49.5 g）, LVMI（ HMS：123. 3±40. 6 vs NMS：109.9±32.8 vs control：103.1±31.6 g/m^2）. WhileEvalue（HMS：0.6±0.2 vs NMS：0.7±0.2 vscontrol：l.0±0.2）, E/A（HMS：0.8 ± 0. 2 vs NMS： 1.0 ±0.8 vs control： 1.3 ± 0.5）, FS and LVEF were decreased in both HMS and NMS groups（P〈0.05）, especially in HMS（FS： HMS： 42.1 ± 9.8 vs control： 34.7 ± 11.3; LVEF： HMS：54.8±13.4 vs control：64.4＋11.5,P±0.01）. Conclusion The left ventricular structure and function were significantly be impaired in patients with metabolic syndrome, even without complicated with hypertension. However, high BP still play a vital role in the remodelling of left ventricular in MS.