原发性高血压伴糖尿病对左室构型的影响

Effects of diabetes mellitus on left ventricular geometry in essential hypertension

目的探讨原发性高血压伴糖尿病对左室肥厚(LVH)和构型的影响。方法回顾性研究2000～2007年住院的高血压患者,将符合该研究标准的病例分为单纯高血压组(n=1 660)和原发性高血压伴糖尿病组(n=953),并分析两组的一般资料、生化指标以及超声心动图检查结果。结果原发性高血压伴糖尿病组患者的年龄、高血压病程、体质量指数、收缩压、空腹血糖及甘油三酯均高于单纯高血压组(P<0.01),而高密度脂蛋白胆固醇(HDL-C)低于单纯高血压组(P<0.05);原发性高血压伴糖尿病组的左室舒张期内径(LVDd)、左室间隔厚度(LVST)、左室后壁厚度(PWT)、左室质量指数(LVMI)及相对室壁厚度(RWT)均高于单纯高血压组(P<0.01)。与LVH发生相关的危险因素为糖尿病、高血压病程、血压分级及慢性肾功能不全。结论原发性高血压伴糖尿病患者的左室构型改变较单纯高血压患者明显,糖尿病对LVH的影响独立于其他危险因素;其他与LVH发生相关的危险因素有高血压病程、血压分级和慢性肾功能不全。

Objective To explore the effects of diabetes mellitus on the left ventricular geometry in essential hypertension （EH）. Methods Patients with hypertension admitted between 2000 to 2007 were retrospectively analysed. Those meeting the study criteria were divided into EH group（ n = 1 660） and EH with diabetes mellitus group（ n = 953）. The general data, biochemical parameters and echocardiographic findings were analysed. Results Compared with EH group, the age, course of hypertension, body mass index, systolic blood pressure, fasting blood glucose and triglyceride were increased （P 〈 0.01）, and high density lipoprotein-cholesterol was decreased （P 〈 0. 05） in EH with diabetes mellitus group. Left ventricular diastolic diameter, left ventricular septum thickness, posterior wall thickness, left ventricular mass index and relative wall thickness were higher in EH with diabetes mellitus group than those in EH group （ P 〈 0.01）. The factors associated with left ventricular hypertrophy were course of diabetes mellitus, course of hypertension, blood pressure level and chronic renal failure. Conclusion Left ventricular remodeling appears more significantly in those with EH and diabetes mellitus than those with EH. Diabetes mellitus is an independent risk factor for left ventricular hypertrophy, and the other risk factors associated with LVH are course of hypertension, blood pressure level and chronic renal failure.