代谢综合征对高血压患者左室肥厚的影响

Influence of Metabolic Syndrome on the Left Ventricular Hypertrophy in Hypertensive Patients

目的探讨代谢综合征(MS)对高血压患者左室肥厚(LVH)的影响。方法选择321例原发性高血压病人,其中单纯高血压187例,男性86例,女性101例,年龄(61.0±11.3)岁;高血压合并MS(参照美国成人胆固醇教育计划NCEP-ATPⅢ2001提出的MS的诊断标准)134例,男性55例,女性79例,年龄(61.0±9.7)岁。测定所有患者超声心动图的各种参数,计算左室质量指数(LVMI)和相对室壁厚度(RWT)。入选患者排除糖尿病、继发性高血压、缺血型心肌病、脑血管疾病、肝肾功能不全、心力衰竭(NYHAⅡ、Ⅲ)。结果1)高血压合并MS组病人左室舒张末期内径(LVEDd)、室间隔舒张末期厚度(IVSD))、左室后壁舒张末期厚度(LVPWd)、LVMI均明显高于单纯高血压组,P均<0.01。2)高血压合并MS组左室结构正常(NG)的比例明显低于单纯高血压组(11.9%vs 26.7%,P<0.05),而向心性肥厚(CCH)的比例明显高于单纯高血压组(20.2%vs 8.6%,P<0.05)。两组向心性重构(CCR)和离心性肥厚(ECH)的比例无差异(P>0.05)。3)高血压合并MS组病人LVH的比率明显高于单纯高血压组(26.1%vs 11.2%,P<0.01)。4)多因素回归分析只有SBP和腹围与LVMI相关,腹围与LVMI呈显著正相关(r=0.692,P<0.01)。结论MS对高血压LVH有显著的影响。除血压外,腹围是LVH的一个独立预测因子。对LVH的干预,不仅要纠正血流动力学异常,拮抗神经体液的激活,还应对MS各因素积极干预,控制体质量,以有效的逆转LVH。

Objective To evaluate the influence of metabolic syndrome （MS） on the left ventricular hypertrophy in non-diabetic hypertensive patients. Methods A total of 321 essential hypertensives were included in which 134 patients were diagnosed as MS （EH＋MS）, 187 patients with hypertension alone （EH） as controls. Left ventricular mass index （LVMI） and relative wall thickness （RWT） were determined by echocardiography. Results Compared with hypertension alone （EH） patients, hypertensive patients with MS （EH＋ MS） were shown to have greater end-diastolic left ventricular internal dimension （LVEDd）, end-diastolic interventricular septum thickness （IVSD）, end-diastolic posterior wall thickness （LVPWd） and left ventricular mass indexed （LVMI）（P〈0. 01）, indicating more prevalent of LVH （EH＋MS： 26.1% vs EH： 11.2%, P〈0. 01）. Prevalence of normal left ventricular geometry（NG） was lower in EH＋MS （EH＋MS：11. 9% vs EH：26.7%, P〈0. 05） while the incidence rate of ventricular concentric hypertrophy（CCH） was significantly higher （EH＋MS：20. 20/60 vs EH：8.6%, P〈0. 05）. No significant difference was found in ventricular concentric remodeling（CCR） and ventricular eccentric hypertrophy （ECH） between these two groups （ P〉0. 05）. Left ventricular mass index （ LVMI） was strongly related with waist circumstance （r=0. 692, P〈0. 01）. Conclusion Metabolic syndrome is associated with left ventricular hypertrophy （LVH） in hypertensive patients. Abdominal obesity and BP are the 2 independent risk factors of LVH. Therefore, to prevent and reverse the progress of LVH＇effectively, it is necessary to not only reduces the abnormal high blood pressure, but also all the risk factors involved by MS is strongly advocated.