心肌最大弹性膜量在原发性高血压左室收缩功能评价中的应用

Application of myocardial Emax in evaluating the left ventricular systolic function of essential hypertension

目的研究用最大弹性膜量(Emax)评价原发性高血压(EH)左室重构的生物力学特性及其临床意义。方法研究对象为96例EH患者(EH组)和30例健康人(正常对照组)。应用超声心动图测定左室收缩及舒张末期内径、左室收缩末期容量、重量指数(LVMI)和相对室壁厚度(RWT)、射血分数(EF)、短轴缩短率(FS)。根据LVMI和RWT将EH患者分为左室正常构型亚组、向心性重构亚组、向心性肥厚亚组、离心性肥厚亚组。应用上述各测值计算最大弹性膜量(Emax)。结果①EF、FS正常对照组分别为(62.74±1.04)%、(34.13±0.78)%,高血压正常构型亚组为(62.24±1.31)%、(33.71±1.96)%,向心性重构亚组为(64.29±1.26)%、(34.96±0.93)%,向心性肥厚亚组为(63.44±1.29)%、(34.69±0.97)%,离心性肥厚亚组为(60.13±2.08)%、(32.68±1.45)%;以EF、FS表示的心脏收缩功能在正常对照组与EH各亚组间、EH各亚组间差异无统计学意义(P>0.05)。②Emax正常对照组为(0.209±0.0014)mmHg/ml,高血压正常构型亚组为(0.520±0.0075)mmHg/ml,向心性重构亚组为(0.697±0.0084)mmHg/ml,向心性肥厚亚组为(0.827±0.0155)mmHg/ml,离心性肥厚亚组为(0.771±0.0129)mmHg/ml。Emax在EH组呈现增高的趋势;在正常对照组与EH各亚组间差异有统计学意义(P<0.01);EH各亚组间Emax差异亦具统计学意义(P<0.01)。结论应用超声心动图无创测定心功能力学参数Emax对EH左室重构心肌生物力学特性的评价具有特殊的诊断价值。

Objective：To explore the biomechanics characteristic of essential hypertension left ventricular remodeling by using maximum elastic（Emax）. Method：The left ventricular end-systolic and end-diastolic dimensions and end-systolic volume, the left ventricular mass index （LVMI）, relative wall thickness （RWT）, and ejection fraction（EF）, short-axis shorting fraction（FS） were determined by echocardiograpby in 96 cases of essential hypertension and 30 normal control subjects. The brachial blood pressure were recorded to calculate the left ventricular end-systolic pressure. To divide hypertension groups were divided into LV normal geometric patterns, LV concentric remodeling patterns,LV concentric hypertrophy patterns and LV eccentric hypertrophy patterns by the LVMI and RWT. The data got from the echocardiography were used to calculate the Emax. Result： OThe EF and FS in control group were 62.74±1.04 and 34. 13±0. 78, in LVN were 62.24±1.31 and 33.71±1.96,in LVCR were 64. 29±1.26 and 34.96±0. 93,in LVCH were 63.44±1.29 and 34.69±0.97,in LVEH were 60. 13±2. 08 and 32.68± 1.45. The LV systolic function showed with EF and FS had no significant difference between normal control group and hypertension groups （P〉 0. 05）. （2）The Emax in control group was 0. 209 ± 0. 0014, in LVN was 0. 520±0. 0075, in LVCR was 0. 697 ± 0. 0084, in LVCH was 0. 827 ± 0. 0155, in LVEH was 0. 771 ± 0. 0129. Emax of normal group arid hypertension groups had significant difference（P〈0. 01 ） ;Emax increased and had significant difference in different hypertension groups （P〈0. 01 ） . Conclusion： Heart mechanical index of Emax got from echocardiography without invasion has special clinical value in evaluating the biomechanical characteristic of hypertension left ventricular remodeling.