高血压患者室间隔增厚与颈动脉粥样硬化的相关性研究

Correlation between increased thickness of interventricular septum and carotid atherosclerosis in hypertensive patients

目的:探讨高血压患者室间隔增厚与颈动脉粥样硬化之间的相关性。方法:收集2005年5月至2008年9月在本院经查冠脉CTA排除冠心病的高血压患者共152例,首先根据心彩超结果将资料分为有无室间隔增厚2组,对其影响因素行单因素及多因素分析;再比较2组间各因素均数的大小;最后建立ROC曲线评估IMT及Crouse评分预测室间隔增厚的价值。结果:高血压患者室间隔增厚的发生率在颈动脉IMT>8mm与≤8mm组之间有统计学意义(χ2=5.544,P=0.019);颈动脉的IMT、斑块的Crouse评分、SBP对高血压患者室间隔增厚有影响(ORIMT=36.349,PIMT=0.022;ORCrouse=1.151,PCrouse=0.043;ORSBP=1.025,PSBP=0.053);高血压患者有无室间隔增厚2组间SBP(P<0.05)、颈动脉的IMT(P<0.01)及斑块的Crouse评分(P<0.01)差异均有统计学意义;以颈动脉IMT及斑块的Crouse评分预测高血压患者室间隔增厚的ROC曲线下面积AUC均为0.669(P<0.05;P<0.01)。结论:高血压患者颈动脉粥样硬化及斑块形成是其室间隔增厚的主要危险因素,但颈动脉IMT及斑块的Crouse评分均不是预测其室间隔增厚的很好指标。

Objective To investigate the correlation between increased thickness of interventricular septum （IVS） and carotid atherosclerosis in hypertensive patients. Methods From May 2005 to September 2008, the clinical data of 152 hospitalized hypertensive patients without complication of coronary artery disease diagnosed by examination of coronary computed tomographic angiography （CTA） were collected. The data were divided into two groups with or without increased thickness of IVS according to the examination by echocardiography. Univariate and multivariate analysis were used for screening the risk factors for the increased thickness of IVS. The mean of the factors were compared between the two groups. The receiver operating characteristic （ROC） curves were used for evaluating the sensitivity and specificity of IMT and Crouse score in predicting the increased thickness of IVS in hypertensive patients. Results The incidence of increased thickness of IVS in hypertensive patients with carotid IMT 〉 0.8 mm was significantly higher than that in the hypertensive patients with carotid IMT ≤ 0.8 mm （X^2 = 5.544,P = 0.019）. The increased thickness of IVS in hypertensive patients was correlate with carotid IMT （OR = 36.349, P = 0.022）, Crouse score of carotid plaque （OR = 1.151, P = 0.043 ）, and systolic pressure （OR = 1.025, P = 0.053）. Statistically significant differences of the carotid IMT （P 〈 0.05）, Crouse score of carotid plaque（P 〈 0.01 ）, and systolic pressure （P 〈 0.01 ） were found between the groups with or without increased thickness of IVS in hypertensive patients. The areas under ROC curve of the carotid IMT and Crouse score of carotid plaque in predicting increased thickness of IVS in hypertensive patients were both 0.669 （P 〈 0.05 and P 〈 0.01, respectively）. Conclusion The formation of carotid atherosclerosis and plaque are the major risk factors of increased thickness of ITS in hypertensive patients, but both carotid IMT and Crouse score of carotid plaque are not accurate predictors of increased thickness of IVS in patients with hypertension.