超高龄高血压病左室肥厚与神经体液因素及室性早搏的相关性研究

Study on the Relation between Hypertensive Left Ventricular Hypertrophy with Neurohormonal Factors and Ventricular Arrhythmias in very Old Persons

目的 探讨超高龄 (>80岁 )高血压病左室肥厚与部分神经体液因素之间的关系及与室性早搏、心肌缺血的相关性。方法 6 0例病人分 2组 :超高龄高血压病伴左室肥厚 30例为A组 ;单纯超高龄高血压病 30例为B组。对比观察心率变异、肾素 (Ren)、血管紧张素 (AT Ⅱ )、醛固酮 (Ald)、胰岛素峰值 (Ins)、2 4小时动态心电图和血压等指标。结果 (1)A组病人交感神经张力明显增高 ,迷走神经活性下降不明显 ;交感神经张力增高与室性早搏的发生有关 ;室性早搏与心肌缺血具有相关性 ;(2 )A组病人与Ald及Ins水平有关 ,与Ren和AT Ⅱ无明显相关 ;(3)A组病人与室性早搏和心肌缺血具明显相关。结论 超高龄高血压病左室肥厚患者交感神经张力增高 ,Ald及Ins水平升高 ,与室性早搏、心肌缺血具有正相关。

Objective\ To study the relation between hypertensive left ventricular hypertrophy (LVH) in very old people (>80 y/o) with neuro hormonal factors and ventricular arrhythmias. Methods\ Measurements were made on the heart rate variation, renin(Ren), angiotensin Ⅱ(AT Ⅱ), aldosterone(Ald), insulin(Ins),Holter and ambulatory blood pressure monitor in 60 cases of 2 groups:30 cases with primary hypertension in very old people and LVH(group A); 30 cases with simple primary hypertension in very old people (group B). Results\ (1)There was no significant difference of AT Ⅱand renin among group A,B ( P >0 05);(2)Ins and Ald value in group A was much higher than group B (P all<0 01);(3) Very lower frequency (VLF) and low frequency (LF),LF/HF in group A were significantly higher than group B( P <0 01,0 05,0 05,respectively); (4)incidence of premature ventricular beats and myocardial ischemia in group A were higher than those in group B. Conclusions\ (1)Sympathetic nerve excitability in group A was greatly increased; (2) Hypertensive LVH were closely associated with Ald and Ins level, but not with AT Ⅱand Ren; (3) there was obvious correction between group A and premature ventricular beats and heart muscle ischemia.