老年高血压左心室肥厚患者左心室重构和冠状动脉病变分析

Analysis of coronary lesion and left ventricular remodeling in old primary hypertensive patients with left ventricular hypertrophy

目的老年高血压左心室肥厚(left ventricular hypertrophy,LVH)患者左心室重构和冠状动脉病变发生及严重程度分析。方法选择高血压患者553例,根据年龄以及是否合并LVH,分为非老年非LVH组(A组,1 41例),非老年LVH组(B组,86例),老年非LVH组(C组,196例),老年LVH组(D组,130例),比较各组危险因素伴发情况、生化指标、冠心病发生、冠状动脉病变严重程度及心脏超声结果。结果与A组比较,其余3组的冠状动脉造影阳性率明显升高;B组和D组高血压3级比例、冠状动脉3支病变率明显升高(P<0.05,P<0.01);C组和D组的二尖瓣舒张早期血流峰值速度和舒张晚期血流峰值速度的比值明显降低;B组和D组的左心房内径、左心室舒张末内径、左心室收缩末内径、左心室重量指数明显增加,LVEF明显降低(P<0.01)。C组心脏超声指标较D组变化明显,差异有统计学意义(P<0.01)。结论老年高血压LVH患者高血压病程长,高血压程度严重,冠状动脉狭窄发生率高且病变程度更严重,心脏收缩与舒张功能显著降低。

Objective To study the coronary lesion and left ventricular remodeling in old primary hypertensive patients with left ventricular hypertrophy（LVH）. Methods Five hundred and fiftythree patients with primary hypertension were divided into the young LVH group（group B）,the young non-LVH group（group A）,the old LVH group（group D）,the old non-LVH group（group C）. They underwent diagnostic coronary angiography and echocardiography. The risk factors in- cluding type-2 diabetes mellitus, hyperlipidemia and smoking ; uric acid, blood sugar, TC, TG, HDL and LDL were measured and compared among the four groups. Results The rate of coronary stenosis was higher in groups B,C and D than in group A,and was higher in group D than in group C. The proportion of grade 3 hypertension of groups B and D was higher than that of group A,the group D was higher than group C. The rate of three branch lesion of groups B and D was higher than that of group A,and the group D was higher than group C. Compared with group A,the rate of E/A of groups C and D was lower;the diameters of left atrium,LVEDD,LVESD and LVMI of groups B and D were larger;the LVEF of groups B and D was lower. The changes of echoeardi of graphic parameters of group C were more significant than those of group D. Conclusion In the old hypertensive patients with LVH the course of hypertension is long, the hypertension is se- vere,the incidence of coronary stenosis is high and the lesion is severe,the systolic and diastolic function of heart significantly decrease.