北京市住院高血压患者心脏舒张期顺应性下降的危险因素分析

Analysis of risk factors related to the decrease in cardiac diastolic compliance in in-patients with essential hypertension

目的了解住院高血压患者的心脏舒张期顺应性改变与年龄、血压水平、及各研究因素之间的关系,分析可能影响心脏舒张功能的相关因素。方法应用回顾性研究的方法调查北京市20家三级医院住院高血压患者2 971例,通过调查表获得一般情况、血压水平、遗传史、用药史、血生化、超声心动图等指标。结果在超声心动图检查左心室射血分数(LVEF)≥45%的2 971例患者中,左心室舒张早期二尖瓣最大血流速度和舒张晚期二尖瓣最大血流速度之比(E/A)异常的1 793例(60.4%)。回归分析显示,年龄、动脉粥样硬化斑块、早发心血管病家族史、糖尿病史、左心室舒张末期内径(LVEDD)、室间隔厚度、LVEF、病程等指标在E/A正常和异常之间存在显著差异。结论高龄、合并周围血管动脉粥样硬化、早发心血管病家族史、糖尿病、LVEDD舒张受限、室间隔增厚、高血压病程是高血压患者舒张期顺应性下降的相关危险因素,对于上述高危因素的干预有利于心室舒张功能的改善。

Objective To investigate the relationship between cardiac diastolic compliance and some factors in hypertensive in-patients and analyze the associated factors which influence the cardiac diastolic function. Methods Retrospective research was used to investigate 2 971 hypertensive patients in about 10 hospitals in Beijing. The items investigated included general conditions, blood pressure level, genetic history, treatment history, laboratory parameters and heart structure and function measured by echocardiograghy. Resdts Of the 2 971 patients with normal systolic function （LVEF 〉i 45 % ）, 60.4% had abnormal E/A. The multi-vaviate logistic regression analysis showed that there were significant differences in age, atherosclerotic plaques, family history of early cardiovascular disease, diabetes, LVEDD, IVS, LVEF and long hypertension history between groups with normal and abnormal E/A ratio. Conclusion The associated risk factors of decreased diastolic compliance were advanced age, peripheral vascular atherosclerosis, family history of early cardiovascular disease, diabetes, limited LVEDD, increased IVS thickness, decreased LVEF and long hypertension history. Intervention to these risk factors may benefit the improvement of ventricular diastolic function.