QT间期离散度与左心室肥厚的关系及依那普利对其影响

Relationship Between QT Dispersion and Left Ventricular Hypertrophy and the Effect of Enalapril

目的：探讨ＱＴ间期离散度（ＱＴｄ）与左心室肥厚的关系及依那普利治疗对其的影响。方法：选择高血压病（ＥＨ）患者５７例，其中合并左心室肥厚（ＬＶＨ）者（ＥＨ＋ＬＶＨ组）３０例，无合并左心室肥厚者（ＥＨ－ＬＶＨ组）２７例；正常对照者（正常对照组）２４例。用超声心动图仪检测法求得左心室重量，同时从心电图上测得ＱＴｄ与校正后ＱＴｄ（ＱＴｃｄ）。ＥＨ＋ＬＶＨ组患者用依那普利治疗６个月。结果：①ＥＨ＋ＬＶＨ组患者ＱＴｄ与ＱＴｃｄ明显大于ＥＨ－ＬＶＨ组和正常对照组，而ＥＨ－ＬＶＨ组和正常对照组间无显著性差异；②ＱＴｄ和ＱＴｃｄ与左心室重量呈显著正相关（ｒ＝０．７５，Ｐ＜０．０５及ｒ＝０．６１，Ｐ＜０．０５）；③治疗６个月后，ＱＴｄ和ＱＴｃｄ、左心室重量均降低，且ＱＴｄ缩小程度（ΔＱＴｄ）、ＱＴｃｄ缩小程度（ΔＱＴｃｄ）与左心室重量减轻程度（ΔＬＶＭ）亦呈显著正相关。结论：左心室肥厚是高血压病患者ＱＴｄ增大的主要原因；ＱＴｄ可作为左心室肥厚程度的评估指标；依那普利能有效逆转左心室肥厚，减小ＱＴｄ。

? Objective:To study the relationship between QT dispersion(QTd)and left ventricular hypertrophy(LVH)and the effect of enalapril. Methods:Fifty seven patients with essential hypertension(EH)including 30 with LVH(EH+LVH group)and 27 without LVH(EH-LVH group),and 24 normal controls(NC group)were studied.Left ventricular mass(LVM)was measured by echocardiography,QTd or QTc dispersion(QTcd)by electrocardiogram.Patients of the EH+LVH group were treated with enalapril for six months. Results:①QTd and QTcd of the EH+LVH group were significantly larger than of the EH-LVH and NC group(p<0.05).No significant difference was found between the EH-LVH and NC group.②QTd and QTcd are positively related to LVM(r=0.75,p<0.05 and r=0.61,p<0.05)respectively.③QTd,QTcd and LVM of patients of the EH+LVH group were decreased after enalapril treatment for six months,ΔQTd and ΔQTcd are positively related to ΔLVM. Conclusion:LVH is the main causative factor for the increase of QTd.QTd is of predictive value in the assessment of LVH.Enalapril can effectively decrease LVH and QTd.