比索洛尔对原发性高血压不同类型左室重构患者心率震荡现象的影响

The Effect of Bisoprolol on Heart Rate Turbulence of Different Pattern of Left Ventricular Remodeling in Patients with Essential Hypertension

目的研究原发性高血压(EH)不同类型左室重构患者的心率震荡现象及比索洛尔的干预效应。方法首次确诊EH患者242例,按照心脏彩色多普勒显像特点分为左室正常结构(NG)组(n=59)、向心性重构(CCR)组(n=58)、向心性肥厚(CCH)组(n=61)和离心性肥厚(ECH)组(n=64),根据是否服用比索洛尔,各组随机设立基础治疗组与比索洛尔治疗组,利用24 h动态心电图分析系统获得其室性早搏,分别计算治疗前及治疗后4周不同分组的震荡初始(TO)和震荡斜率(TS)。结果EH不同类型左室重构者均存在震荡初始值异常[ECH组(0.58±0.63)%>CCH组(0.39±0.38)%>CCR组(0.19±0.32)%,P<0.01]及震荡斜率异常[ECH组(2.54±1.13)<CCH组(5.12±1.26)<CCR组(14.21±0.46)ms/RR,P<0.01],震荡初始值及震荡斜率值在CCR组与NG组无区别(P>0.05)。与治疗前比较,治疗后4组中基础治疗组和比索洛尔组震荡初始值均显著降低,震荡斜率值均显著升高(P<0.01);协方差分析显示,扣除治疗前震荡初始值和震荡斜率的影响后,比较其校正均数,比索洛尔治疗较基础治疗能进一步降低CCH组和ECH组的震荡初始值(F=8.26,F=10.42,均P<0.01),升高其震荡斜率值(F=15.81,F=9.85,均P<0.01),而在NG组和CCR组中,比索洛尔治疗和基础治疗对震荡初始值及震荡斜率的影响无显著差别。结论EH患者心率震荡现象与其左室重构类型有关,左室重构越明显,其心率震荡异常现象越严重,表现为震荡初始值明显增高,震荡斜率明显下降。比索洛尔可改善EH并左室CCH或ECH患者的心率震荡现象。

Objective To study the effect of bisoprolol on change of heart rate turbulence （HRT） in essential hypertension patients with different types of left ventricular remodeling. Methods Two hundred and fortytwo patients with essential hypertension were divided into normal （NG） group （n= 59）, concentric remodeling （CCR） group （n^58）, concentric hypertrophy （CCH） group （n^61） and eccentric hypertrophy （ECH） group （n--64） according to the pattern of the left ventricular remodeling by using echocardiography. Each group was randomly subdivided into conventional treatment group or bisoprolol treatment group. The numbers of ventrieular premature beats were calculated before and after four weeks treatment by 24 h dynamic electrocardiography. Turbulence onset （TO） and turbulence slope （TS） of the each groups were calculated. Results TO were de- clined in a graded manner from ECH to CCR [ in ECH （0.58＋0.63）G 〉CCH （0. 39＋0.38）G 〉CCR （0. 19＋0.32） G, P〈0.01], while TS were correspondingly increased [in ECH （2.54 ＋1.13） 〈CCH （5.12＋1.26） 〈CCR （14.21＋0.46）ms/RR, P〈0.01]. No significant difference of TO and TS between NG and CCR. Four weeks both bisoprolol and conventional treatment significantly decreased TO and increased TS. Covariance analysis revealed that the impact of bisoprolol on TO and TS were more significant in CCH and ECH patients than that by conventional treatment, with little effect on NG and CCR patients. Conclusion Heart rate turbulence was related to the features of left ventricular remodeling in patients with essential hypertension. The more serious left ventricular remodeling, the more pronounced abnormality in HRT was found. Bisoprolol improve the irregularity of heart rate turbulence in CCH and ECH patients but not in NG and CCR patients.