影响氢氯噻嗪、卡托普利联用降低左室质量指数的相关因素分析

Investigation of factors related to determinants of left ventricular mass index reduction with hydrochlorothiazide combined captopril in hypertensive patients

目的探讨影响氢氯噻嗪(HCTZ)与卡托普利长期联用降低高血压患者左室质量指数(LVMI)的相关因素。方法采用多中心双盲研究设计,选择并入选轻、中度高血压患者109例。给予安慰剂洗脱2周和HCTZ(12.5 mg每天1次)导入6周,导入期结束后加服卡托普利(25 mg,每天2次),共服药36个月。治疗期间每月随访1次,监测血压。洗脱期末和治疗12、24、36个月末行超声心动图检查,并同期采静脉血进行实验室检查,最终将可能影响LVMI下降幅度的相关因素进行多元线型回归分析。结果 (1)治疗36个月末,向心重构、向心肥厚、离心肥厚型患者的LVMI较治疗前分别下降(7.7±17.3)g/m^2(P<0.05)、(57.4±29.2)g/m^2(P<0.01)、(40.3±26.7)g/m^2(P<0.01),校正治疗前LVMI后与心室正常构型比较,向心肥厚、离心肥厚型患者LVMI下降幅度差异有统计学意义(P<0.01);(2)多元线性回归分析表明,LVMI下降与治疗前LVMI、向心肥厚型、△SBP呈正相关,偏相关系数分别为0.71、0.22、0.20(均P<0.05)。结论治疗前LVMI、△SBP、向心肥厚型影响HCTZ与卡托普利联用降低LVMI的幅度。

Objective To explore factors related to determinants of left ventricular mass index（LVMI） reduction with hydrochlorothiazide（HCTZ） combined captopril in hypertensive patients.Methods A multicentre, double blind,randomized study was performed.Nine hospitals including Kailuan coal mining industry hospital took part in the trial.After 2 weeks＇washout period and 6 weeks＇leading period,the eligible patients accepted captopril 25 mg Bid.Monitored blood pressure（BP） every month during 36 months of treatment.At the end of washout period and 12,24,36 months,all subjects underwent a complete echocardiography study,we calculated LVMI and drew blood from their elbow vein to perform correlative examination.At end of study,multivariable linear regression analysis （step-wise backward method） was applied to evaluate the association of percentage LVMI reduction.Results （1） After 36 months＇treatment,a significant reduction of LVMI was observed in concentric remodeling,concentric hypertrophy,eccentric hypertrophy,（7.7±17.3） g/m^2（P0.05）,（57.4±29.2） g/m^2（P0.01）,（40.3±26.7） g/m^2（P0.01） respectively,and reduction of LVMI was also significant after adjusting for pretreatment value （P0.01 ）.（2） In multivariable linear regression analysis,the high left ventricular mass index reduction was related to pretreatment LVMI,concentric hypertrophy and reduction of SBP after treatment,standardized coefficient was 0.71,0.22,0.20（P0.05） respectively.Conclusion In essential hypertension,pretreatment LVMI,concentric hypertrophy of left ventricular geometry and reduction of SBP are independent determinants of LVMI reduction.