非洛地平对高血压患者QT间期离散度和左室重构的影响

Effects of Felodipine on left ventricular remodeling and dispersion of QT interval

目的:通过用药前后左室重量指数和QT间期离散度的检测比较,评价非洛地平对轻中度高血压患者左室重构和电学重构的影响。方法:入选1、2级高血压患者25例,经过导入期2周后予非洛地平缓释片每天5～10mg口服3个月。治疗前后行12导联心电图及心脏超声检查,测量并计算校正的QT间期离散度(QTcd)和左室重量指数(LVMI)。同时设立性别和年龄相匹配的健康对照组25例,测量并计算QTcd和LVMI。比较两组间及治疗组内用药前后的参数变化,以及两参数变化的关系。结果:用药后患者的收缩和舒张压均较用药前显著降低[(151±6/97±3)mmHgvs(136±7/85±7)mmHg,P<0.01],降压显效者15例,有效者9例,无效者1例,总有效率达96.0%。与正常对照组[QTcd(38±7)ms,LVMI(89±14)g/m2]相比,研究组患者用药前、后的QTcd与LVMI均显著增加[用药前QTcd与LVMI分别为(58±18)ms,(132±12)g/m2,P<0.05;用药后分别为(44±16)ms,(109±13)g/m2,P>0.05];与用药前相比,用药后QTcd与LVMI显著降低,P<0.05。采用直线相关分析,QTcd在用药前后的改变与LVMI用药前后的改变呈显著性相关(r=0.52,P<0.05)。结论:高血压患者由于长期的血压负荷,即使是1、2级的血压水平也可导致心脏结构和电活动特性的重构。治疗高血压不单纯是降低血压,还要积极控制和逆转心脏重构。非洛地平不仅可有效地控制血压,使其达标,还能进一步降低LVMI和QT间期的离散度,改善和逆转心脏重构。

AIM：To evaluate the effects of felodipine on left ventricular and electrical remodeling by measuring left ventricular mass index （LVMI） and dispersion of corrected QT interval （QTcd）. METHODS：25 patients with class 1 or 2 primary systemic hypertension were treated with felodipine sustained-release tablets 5-10 mg per day for 3 months after 2 weeks introduction period. Twelve leads ECG and cardiac ultrasound examination were performed before and after treatment to obtain QTcd and LVMI. The control group included 25 normal persons matched in age and sex with study group. RESULTS：After treatment,the patients＇ systolic and diastolic blood pressure were significantly reduced [（151±6/97±3） mm Hg vs （136±7/85±7） mm Hg,P〈0.01] with the total effectiveness of 96.0%. Compared with control group,the QTcd and LVMI before treatment were significantly higher [QTcd（38±7） ms vs （58±18） ms,LVMI （89±14） g/m^2 vs （132±12） g/m^2,both P0.05]. Compared with pretreatment,the QTcd and LVMI after treatment were significantly lowered [（44±16） ms,（109±13） g/m^2,P〈0.05]. A significant correlation between the change of QTcd and LVMI was observed by linear correlation analysis （r=0.52,P〈0.05）. CONCLUSION：Patients with hypertension,even in class 1 or 2,may have significant left ventricular structural and electrical remodeling. The aims of anti-hypertension treatment are not only to control blood pressure,but also modify and reverse the remodeling of heart. Felodipine can effectively control the blood pressure,and reverse the heart remodeling by reducing the LVMI and QTcd.