高血压及左心室肥厚患者的心肺运动功能

Reduced cardiopulmonary exercise capacity in patients with essential hypertension： impact of left ventrtcular hypertrophy

目的评估高血压及伴左心室肥厚（LVH）患者心肺运动功能改变并探讨LVH对心脏贮备功能的影响。方法对70例原发性高血压（EH）患者根据超声心动图测定的左心室质量指数（LVMI）分为LVH组和非LVH组，选健康体检者为对照组。应用内置同步12导联心电图的运动心肺功能仪测定和比较各组在分级递增运动后达无氧阈（AT）和最大摄氧量（VO2max）时的代谢当量（METs），摄氧量（VO2），公斤体重摄氧量（VO2／kg），和每搏摄氧量（VO2／HR）。结果（1）在达AT值时，EH并LVH组和非LVH组METs和VO2／kg均低于对照组[METs：3．57±0．8和4．34±1．47比5．21±1．45，P〈0．01；VO2／kg：（12．38±2．85）ml·min^-1·kg^-1和（14．42±4．33）ml·min^-1·kg^-1比（18．48±4．52）ml·min^-1·kg^-1，P〈0．01]，EH并LVH组的降低较非LVH组差异也有统计学意义（P〈0．05）。（2）在VO：max时，EH并LVH组和非LVH组METs和VO2／kg均低于对照组[METs：4．94±1．24和5．90±1．51比6．96±1．85；V02／kg：（17．20±4．34）ml·min^-1·kg^-1和（20．41±4．59）ml·min^-1·kg^-1比（24．04±5．21）ml·min^-1·kg^-1，P均〈0．01]，EH并LVH组的降低较非LVH组差异也有统计学意义（P〈0．05）。（3）经相关分析显示，EH并LVH组LVMI与VO2／kg呈显著负相关（在AT值R=-0．40，在VO2max值R=-0．31，P〈0．01）。结论EH患者心肺运动指标METs和VO2／kg降低，运动耐量受损，并与LVMI增高相关。提示EH患者心脏贮备功能下降。

Objective To evaluate the cardiopulmonary exercise capacity in patients with essential hypertension （EH） complicating with or without left ventricular hypertrophy （LVH）. Methods Graded maximal exercise test on the bicycle ergometer with respiratory gas analysis were performed in 30 gender and age matched normotensive controls, 40 EH patients without LVH and 30 EH patients with LVH （ LVMI 〉 125 g/m^2 in males and 〉 120 g/m^2 in females）. Metabolic equivalents （METs）, oxygen uptake（ VO2 ）, oxygen uptake to body mass ratio （VO2/kg）and oxygen uptake to heart beat ratio （VO2/HR） at time of reaching anaerobic threshold （AT） and at maximal oxygen uptake （VO2max） were measured and compared. Results METs and VO2/kg were significantly reduced in EH patients with or without LVH compared with controls [ at AT, METs- 3. 57 ± 0. 8 and 4. 34 ± 1.47 vs. 5.21 ± 1.45 ; VO/kg： 12. 38 ± 2. 85 and 14.42 ± 4. 33 vs. 18.48 ± 4. 52, all P 〈 0. 01 ; at VO2 max, METs： 4. 94 ± 1.24 and 5.90 ± 1.51 vs. 6.96＋1.85;VO2/kg：（17.20±4.34） ml·min^-1·kg^-1 and （20.41 ＋4.59 ）ml·min^-1·kg^-1 vs. （24.04± 5.21 ）ml·min^-1·kg^-1 , all P 〈 0. 01 ]. METs and VO2/kg at both time points were also significantly reduced in EH patients with LVH compared EH patients without LVH （ all P 〈 0. 05 ）. The lower VO2/kg in hypertensive patients was significantly correlated to higher LVMI （ P 〈 0. 05 ）. Conclusions Cardiopulmonary exercise capacity was reduced in hypertensive patients, especially in hypertensive patients with LVH.