老年人不同体质对心脏结构、血流、功能及血压的影响

Variation of cardiac structure, blood flow, function and blood pressure in aged subjects with different body mass indexes

目的观察体重对老年人心血管系统的影响。方法６２３例老年人根据体质指数（ＢＭＩ）分为肥胖、超重、正常及消瘦４组，检测血压、空腹血糖（ＢＳ）、胆固醇（ＴＣ）、甘油三酯（ＴＧ）及超声心动图。结果肥胖及超重组较正常体重及消瘦组收缩压（ＳＢＰ）及舒张压（ＤＢＰ）均增高（均为Ｐ＜０．０５），主动脉径（ＡｏＤ）、左房径（ＬＡＤ）、左室舒张及收缩末径（ＥＤＤ及ＥＳＤ）及心肌质量（ＬＶＭ）增加（均为Ｐ＜０．０５）。ＳＢＰ、ＤＢＰ均与体重、ＢＭＩ、ＴＣ、ＬＶＭ及心房收缩期与舒张早期充盈峰值流速（ＡＰＦＶ与ＥＰＦＶ）之比值（Ａ／Ｅ）呈明显正相关（Ｐ＜０．０５、０．０１或０．００１），ＤＢＰ与年龄呈明显负相关（Ｐ＜０．００１）。多元逐步回归分析证实ＬＶＭ、ＡＰＦＶ及ＬＡＤ均与ＢＭＩ呈正相关（均为Ｐ＜０．０１），ＥＰＦＶ与ＢＭＩ呈负相关（Ｐ＜０．０５）；射血分数（ＥＦ）、年龄、ＢＳ与ＳＢＰ呈正相关（Ｐ＜０．０５、０．００１及０．０１），与ＤＢＰ呈负相关（Ｐ＜０．０５或０．００１）。结论体重是影响心脏结构、血流、功能及血压的重要因素；ＥＦ、年龄、ＢＳ是分别影响ＳＢＰ及ＤＢＰ的独立因素。

Objective To evaluate the influence of body weight(W) on cardiovascular system in old subjects. Methods The general physical examinations of 623 elderly subjects aged 60 years and over were performed together with fasting blood sugar (BS), total cholesterol (TC), triglyceride (TG) and echocardiography. The subjects were divided into four groups according to body mass index (BMI): obese (BMI>28), overweight (BMI 24～27), normal (BMI 20～23) and thin (BMI<20). Results Systolic blood pressure (SBP), diastolic blood pressure (DBP), diameters of aorta (AoD) and left atrium (LAD), end diastolic and systolic diameters of left ventricle( EDD, ESD) and left ventricular mass (LVM) were significantly increased in obese and overweight groups (all P<005). There were positive correlation of SBP and DBP with W, BMI, TC, LVM and the ratio of atrial peak flow velocity (APFV) to early diastolic peak flow velocity (EPFV) (A/E)(P<005,001 or 0001 respectively); but negative correlation of DBP with age (P<0001). Stepwise multivariate regression analysis disclosed that LVM, APFV and LAD alone and jointly positively correlated with BMI (all P<001), EPFV negatively correlated with BMI(P<005); ejection fraction (EF), age, BS alone and jointly positively correlated with SBP (P<005,0001 and 001 respectively), and negatively correlated with DBP (P<005 or 0001 respectively). Conclusions W and BMI are important factors influencing cardiac structure, blood flow, function and blood pressure. There are different effects of EF, age and BS on SBP and DBP.