QT离散度与左心室肥厚及氯沙坦对其干预作用

Left venfricular Hypertrophy and QT dispersion in patients with Essenssial Hypertension and the Effect of Losartan

目的 探讨高血压性左室肥厚 (LVH)与其QT间期离散度 (QTd)的关系 ,以及氯沙坦对二者的干预作用。方法 选择高血压病人伴有左室肥厚的 30例和无左室肥厚的 32例。服用losartan 5 0mgqd共 6月。治疗前后 ,用超声心动图 (UCG)检测左室相关参数计算出左室重量 (LVM) ,从心电图上计算出QTd、校正的QT离散度 (QTcd)。结果 EH伴有LVH病人组的QTd(5 4± 16ms)、QTcd(6 7± 2 2ms)、LVM(345 .6± 10 1.2 )明显大于无LVH组的QTd(38± 13ms)、QTcd(42± 18ms)、LVM(16 8.6± 6 7.2g) (P均 <0 0 5 )。QTd(5 4± 16ms)、QTcd(6 7± 2 2ms)、LVM(345 .6± 10 1.2 )分别呈正相关 (r =0 74 ,P <0 0 0 1及r =0 6 3,P <0 0 0 1)。治疗 6月后有LVH组的QTd(5 4± 16ms / 4 0± 12ms,该分子式表示治疗前的数据 /治疗后的数据 ,下同 )、QTcd(6 7± 2 2ms/ 4 9± 17ms)、LVM (345 .6± 10 1.2 g/2 38.8± 89.2 g)较治疗前均有明显降低 (P均 <0 0 5 ) ,且ΔQTd(15± 13ms)、ΔQTcd(18± 15ms)即两者减少的幅度与LVM降低的幅度 (10 7.8± 90 2g)亦分别呈显著正相关 (r =0 6 0 ,P <0 0 0 1及r =0 5 6 ,P <0 0 0 1)。结论 高血压患者左室肥厚可引起QTd、QTcd增大 ,他们可评估左室肥厚的程度。

Aim To investigate the relationship between left ventricular hypertrophy(LVH) and QT dispersion(QTd) and the effect of losartan. Methods Sixty two patients with essential hypertension(EH),30 patients with LVH and 32 patients without LVH, were enrolled into the study and received losartan 50 mg once daily for more than 6 months. The parameters of left ventricular mass(LVM) were examined by echocardiography, and QTd?QTcd (corrected QTd) were measured by electrocardiogram before, and after the theragy. Results The QTd(54±16 ms)?QTcd(67±22 ms)?LVM(345.6±101.2 g) in patients with LVH are significantly higher than that of patients without LVH[QTd(38±13 ms)?QTcd(42±18 ms)?LVM(168.6±67.2 g)](all P value<0 05). QTd and QTcd are positively related to LVM in EH patients with LVH, respectively( r =0 74, P <0 001 and r =0 63, P <0 001. QTd (from 54±16 ms to 40±12 ms), QTcd(67±22 ms to 49±17 ms), LVM(345.6±101.2 g to 238.8±89.2 g) are significantly decreased after six months treatment of losartan(all P value<0 05), and the decreasing degree of QTd(ΔQTd=15±13 ms)?QTcd(ΔQTcd=18±15 ms) are positively related to that of LVM(ΔLVM=107.8±90 2 g), respectively( r =0 60, P <0 001; and r =0 56, P <0 001). Conclusion LVH in patients with EH may associated with high QTd and QTcd. QTd, QTcd and LVM could be effedively lin prored by the treatment of losartan.