增益指数与原发性高血压左室肥厚及心脏功能相关性研究

Correlation of augmentation index with left ventricular hypertrophy and heart function in patients with primary hypertension

目的探讨桡动脉增益指数(radial augmentation index,AIr)与原发性高血压患者左室肥厚和心脏功能的关系。方法前瞻性选取2009年1月至3月在北京大学第三医院心内科住院的患原发性高血压、超声心动图测定的左室射血分数(left ventricular ejection fraction,LVEF)≥50%的患者共102例,分析心率为75次/min标准化的桡动脉增益指数(AIrP75)和超声心动图测量的心脏结构及功能指标的关系。结果 102例患者中男性占68.6%,平均年龄(65.0±9.6)岁。AIrP75与心肌收缩期运动速度峰值(peakmyocardial systolic velocity,Sm)呈负相关(r=-0.24,P=0.017),与左室心肌重量指数(left ventricular massindex,LVMI)呈正相关(r=0.22,P=0.027)。将AIrP75与患者的临床特征及生化指标代入多元线性回归方程,结果显示AIrP75仍与LVMI(β=0.354,s=0.164,sβ=0.214,95%CI 0.028～0.681,P=0.034)及Sm(β=-0.042,s=0.020,sβ=-0.209,95%CI-0.082～-0.002,P=0.040)独立相关。结论本研究结果显示脉搏波增益指数(AIrP75)与左室射血分数正常的原发性高血压患者左室肥厚和心肌收缩功能受损独立相关,提示动脉僵硬度增加可能是原发性高血压患者心脏结构和(或)功能受损的早期标志。

Objective To investigate whether radial augmentation index （Air） is associated with left ventricular hypertrophy and impaired heart function in patients with primary hypertension. Methods Between January and March of 2009, we prospectively enrolled 102 primary hypertension patients registered to Department of Cardiology, Peking University Third Hospital, and with left ventricular ejection fraction （LVEF） was 1〉50%. The corre- lation of radial augmentation index adjusted to a standard heart rate of 75 bpm （ AIrP75 ） with cardiac structures and function as measured by echocardiography were analyzed. Results Of the 102 patients,68.6% were males and the mean age as （ 65.0 ＋ 9.6） years old. AIrP75 was negatively correlated with peak myocardial systolic velocity （Sin） （ r = - 0. 24,P = 0. 017 ） and positively correlated with left ventricular mass index （LVMI） （ r = 0. 22, P = 0. 027）. After adjusted by demographic features and clinical characteristics, AIrP75 remained independently correlated with LVMI （ β = 0. 354, s = 0. 164, sβ = 0. 214,95% CI 0. 028 - 0. 681, P = 0. 034） and Sm（ β = - 0. 042,s = 0. 020, sβ = - 0. 209,95% CI - 0. 082 - - 0. 002,P = 0. 040）. Conclusion In patients with pri- mary hypertension and preserved LVEF, AIrP75 is independently correlated with left ventricular hypertrophy and impaired heart function, suggesting that increased arterial stiffness may be an early marker of structural and/or functional abnormality in primary hypertension.