应用脉冲组织多普勒探讨原发性高血压与胰岛素抵抗对右心室舒张功能的影响

Assessment of Right Ventricular Diastolic Function in Hypertension and Insulin Resistance by Pulsed-wave Tissue Doppler Imaging

目的应用脉冲组织多普勒成像初步探讨原发性高血压与胰岛素抵抗对右心室舒张功能的影响。方法按照2×2析因设计方法,研究对象分为四组,其中健康志愿者35例,单纯胰岛素抵抗者31例,原发性高血压不伴胰岛素抵抗患者36例,原发性高血压伴胰岛素抵抗患者32例,分别测定静息血压、空腹血糖、空腹胰岛素、身高、体重,计算胰岛素抵抗指数及体重指数,并经校正的心尖四腔心切面应用脉冲组织多普勒技术分别测定三尖瓣瓣环外侧壁舒张早期最大运动速度(Em)、舒张晚期最大运动速度(Am)、等容舒张时间(IVRT),经校正的心尖四腔心切面应用脉冲多普勒记录舒张期三尖瓣口的血流频谱,测量右心室舒张早期血流峰值E峰并计算Em/Am、E/Em比值。结果 Em、Am、Em/Am、E、E/Em指标:胰岛素抵抗因素与高血压因素两因素间的交互效应无统计学意义(P>0.05)。IVRT指标:胰岛素抵抗因素与高血压因素两因素间的交互效应有统计学意义(P<0.05)。结论胰岛素抵抗和原发性高血压均可独立影响右心室舒张功能。尚不能认为原发性高血压与胰岛素抵抗对右心室舒张功能产生明显交互效应。

Objective To explore the relationship between essential hypertension and insulin resistance,and right ventricular diastolic function by pulsed tissue Doppler imaging.Methods Thirty-five healthy subjects were as control group,31patients with insulin resistance without essential hypertension,36patients with essential hypertension and without insulin resistance,and 32patients with essential hypertension and insulin resistance were studied.The data of blood pressure,fasting blood glucose,fasting insulin,height,and body weight were collected.Insulin resistance was estimated by the homeostasis model assessment(HOMA-IR).The early diastolic annular velocity(Em),peak diastolic annular velocity with atrial contraction(Am),isovolumic relaxation time(IVRT),and the ratio of Em/Am-dimensional were measure by pulsed-wave tissue Doppler imaging.The peak early diastolic velocity(E),and the ratio of E/ Em were also calculated.Results Em,Am,Em/Am,E,and E/Em were not related with essential hypertension and insulin resistance.There was a relationship between IVRT and essential hypertension and insulin resistance(P<0.05).Conclusion Insulin resistance or essential hypertension could induce right ventricular diastolic dysfunction.There was no significant interaction between essential hypertension and insulin resistance.