高血压左心室舒张功能与血液流变学相关性研究

CORRELATION OF LEFT VENTRICULAR DIASTOLIC FUNCTION AND HEMORHEOLOGY IN HYPERTENSION

目的:应用彩色超声心动图[肺静脉血流(PVF)和二尖瓣血流(MVF)]探讨高血压左心室舒张功能与血液流变学的关系。方法:64例原发性高血压病人根据超声心动图测量左心室质量指数(LVM I)分为左室肥厚组(LVH,31例)和非左室肥厚组(NLVH,33例)。35例正常对照组。二尖瓣血流舒张早期最大血流速度(E),舒张晚期最大血流速度(A)及E、A比值(E/A)。肺静脉血流收缩期峰值流速(Vs),舒张期峰值流速(VD),逆向血流速度峰值AR,Vs和VD比值(S/D),VD与AR比值(D/AR)。血液流变学参数:全血黏度(ηb高切、ηb低切),血浆黏度(ηp),血细胞比容(HCT),纤维蛋白原(FIB),并将测值和计算结果与对照组进行分析比较。结果:高血压LVH组,NLVH组及对照组,E/A值分别为1.15±0.11、0.79±0.13、1.22±0.16,NLVH组与对照组比较,差异有显著性意义(P<0.001),LVH组与对照组比较,差异无显著性意义(P>0.05)。高血压LVH组、NLVH组及对照组,S/D、AR、D/AR参数组间比较,差异均有显著性意义(P<0.05,P<0.01,P<0.001)。对照组、高血压NLVH组、LVH组ηb(150 s-1)、ηb(10 s-1)、ηp、HCT、FIB依次显著升高(P<0.01,P<0.001)。NLVH组:E/A、D/AR分别与ηb(高切)、ηb(低切)、ηp、HCT及FIB呈负相关,S/D及AR与血液流变学各参数呈正相关;LVH组:E/A与血液流变学各参数相关性无统计学意义,D/AR与血液流变学参数呈负相关,S/D及AR与血液流变学各参数呈正相关。结论:1.肺静脉血流图能发现传统二尖瓣血流图假性正常化,肺静脉血流图可能较二尖瓣血流图更为准确地评价高血压左室舒张功能。2.血液流变学异常在高血压左室舒张功能异常改变中可能具有重要作用。

Objective ：To explore the correlation of left ventricular diastolic function and hemorheology, by means of color echocardiography [ pulmonary venous flow （PVF） and mitral valve flow （MVF） ] in hypertension. Methods ：64 cases of patients with essential hypertension were divided into left ventricular hypertrophy （LVH,31 cases） group and non left ventricular hypertrophy （NLVH,33 cases） group according to left ventricular mass index（LVMI） by means of color echoeardiography. 35 healthy subjects were considered as control group. PVF and MVF profile were recorded and the following measurements were obtained：maximal velocity of MVF in early diastole（ E）, maximal velocity in atrial contraction（A） and the ratio of E/A（E/A） ;maximal flow velocity of PVF during systole and diastole （ VS, VD ）, maximal reversal flow velocity during atrial contraction （AR）, the ratio of Vs to VD （S/D） ,and the ratio of VD to AR（D/AR）. The following measured indexes of hemorheology were obtained：ηb（ 150s^-1 ）, ηb （ 10s^-1 ）, ηp, hematocrit （HCT） and fibrinogen （FIB）. The difference was compared and analyzed between the normal control subjects and the essential hypertension groups. Results：The ratio of E/A in NLVH group was lower than that of LVH group and control group （0. 79±0. 13,1.15±0. 11,1.22 ±0. 16 respectively）. NLVH group had significant differences with control group in the E/A（P 〈0. 001 ）. LVH group had no significant differences with control group in the E/A（P 〉0. 05）. Both LVH and NLVH groups had significant differences with control group in PVF （ P 〈 0. 05,P 〈 0. 01, P 〈 0. 001 ）.ηb （ 150s^-1 ）, ηb （ 10s^-1 ）, ηp, HCT and FIB all increased in NLVH group（ P 〈 0. 01 ） and increased further in LVH group（ P 〈 0. 001 ）. There were positive correlations between S/D ratio and AR with the hemorheologic indexes in LVH group and NLVH group. There were negative correlations between D/AR with the hemorheologic indexes in NLVH group and LYH group. The E/A had negative correlations to the hemorheologic indexes in NLVH group ,but no significant correlations in LVH group. Conclusions： 1. Pulmonary venous flow can distinguish the unreal normalcy of traditional mitral ualue flow and may play an important role in differentiating pseudonormalized mitral valve flow. It is available and valuable for combination PVF and MVF to estimate left ventricular diastolic function. 2. The abnormal hemorheologic indexes may play an important role in the patients with essential hypertension of decreased left ventricular diastolic function.