高血压患者动态血压与左心房增大多因素回归分析

Analysis of Dynamic Blood Pressure and Multivariate Regression of Left Atrial Enlargement in Hypertension Patients

目的:高血压病是心脏科常见疾病,本文观察动态血压(ambulatory blood pressure monitoring, ABPM)不同夜间血压类型患者左心房大小并分析左心房增大的独立危险因素。方法:收集86例高血压病患者,所有患者行24小时动态血压及超声心动图检查。根据动态血压中夜间血压下降幅度分为杓形高血压组(夜间血压下降率≥10%, 41例)和非杓形高血压组(夜间血压下降率<10%,45例)。根据心脏超声左心室长轴切面左心房前后径分两组:左心房增大组(前后径≥3.85 cm,45例),左心房正常组(前后径<3.85 cm,41例),采用Logistic多因素回归分析左心房增大的危险因素。结果:(1)非杓形高血压组较杓形高血压组夜间平均收缩压(125.6±15.0 mm Hg VS 107.7±14.9 mm Hg P<0.05)及平均舒张压(70.3±9.0 mm Hg VS 60.3±12.2 mm Hg P<0.05)明显增高,左心房内径明显增大(4.0±0.48 cm VS 3.74±0.35 cm P=0.005)。(2)左心房内径增大组夜间收缩压下降率(6.4±8.1 mm Hg VS10.3±6.7 mm Hg P=0.01)及舒张压下降率(10.1±9.0 mm Hg VS 14.3±7.9 mm Hg P=0.02)较左心房内径正常组明显降低。(3)Logistic多因素回归分析示左心室质量、总胆固醇是左心房增大的独立危险因素。结论:夜间血压升高更容易导致左心房内径增大。左心室质量增加、胆固醇增高与左心房内径增大有密切关系。

Objective: Hypertension is a common disease in cardiology department. The aim of this study was to observe the left atrial size in different nocturnal dynamic blood pressure types and the independent risk factors of left atrial enlargement. Methods: Eighty six hypertension patients were enrolled, all patients were examined 24 hours of dynamic blood pressure monitoring(ABPM)and echocardiography. Patients were divided into two groups by ABPM: dipper hypertension group(night blood pressure drop rate≥10%, 41 cases)and non-dipper hypertension group(night blood pressure drop rate < 10%, 45 cases), and by left atrial size in left ventricular long axis view: left atrial enlargement group(diameter≥3.85 cm, 45 cases)and left atrial diameter normal group(diameter<3.85 cm, 41 cases).Comparison of left atrial diameter was measured between dipper and non-dipper hypertension groups. The risk factors of left atrial enlargement were calculated by Logistic multiple regression analyses. Results: Compared with dipper hypertensive group. The night systolic blood pressure(SBP)(125.6±15.0 mm Hg VS 107.7±14.9 mm Hg P<0.05)and diastolic blood pressure(DBP)(70.3±9.0 mm Hg VS60.3±12.2 mm Hg P<0.05)were higher in non-dipper hypertensive group, and left atrial diameter was larger(4.0±0.48 cm VS 3.74±0.35 cm, P=0.005)as well. Compared with left atrial diameter normal group, the decreased rates of night SBP(6.4±8.1 mm Hg VS 10.3±6.7mm Hg P=0.01) and DBP(10.1±9.0 mm Hg VS 14.3±7.9 mm Hg P=0.02)were lower in left atrial diameter enlargement group. Based on the results of Logistic multiple regression analysis, the independent risk factors of left atrial enlargement included left ventricular mass and cholesterol level. Conclusions: Improper control of nocturnal blood pressure may easy induce the enlargement of left atrium. Increasing of left ventricular mass and total cholesterol level has a closely relation with left atrial enlargement.