瞬时波强技术评价高血压患者左心结构功能与颈动脉弹性变化探讨

Relationship between cardiac structure and function and carotid artery in patients with essential hypertension by using wave intensity technique

目的探讨瞬时波强(WI)技术评价原发性高血压患者左心房结构、左心室功能变化与颈动脉弹性变化。方法原发性高血压患者120例根据左心房内径大小(左心室正常)分为左心房增大组(A组)68例和左心房结构正常组(B组)52例,同时选取年龄及性别匹配的健康体检者50名作为健康对照组(C组),于左心室长轴,应用M型超声心动图测得左心室射血分数(LVEF);应用脉冲式多普勒记录二尖瓣血流频谱,测量左心室舒张早期血流峰值速度E,应用组织多普勒获得左心室侧壁二尖瓣舒张早期峰值血流速度E',并计算E/E';及WI技术中的颈动脉各参数,包括收缩早期正向波(W1)、收缩晚期和部分等容舒张期正向波(W2)、收缩中期负向波(NA)、脉搏波传导速度(PWVβ)、僵硬度(β)、血管压力-应变弹性系数(Ep)和顺应性(AC)。结果 (1)与C组比较,原发性高血压患者的LVEF、E/E'、W1、NA、PWVβ、β和Ep均升高,W2和AC呈下降趋势,差异有统计学意义(均为P<0.05);(2)与B组比较,A组患者的LVEF、E/E'、W1、NA明显升高,而W2和AC明显下降,差异有统计学意义(均为P<0.05)。LVEF与W1呈正相关(r=0.667,P<0.01),E/E'与W2呈负相关(r=-0.584,P<0.01)。结论 WI技术能够评价原发性高血压患者颈动脉弹性及左心结构功能的变化。高血压患者左心房增大时,WI检测指标能够较明显地反映出颈动脉弹性下降及左心室舒张功能减低。

Objective To investigate the wave intensity（ WI） technique in assessment of left atrial structural changes,left ventricular function changes and carotid artery elasticity the patients with essential hypertension. Methods The 120 patients with essential hypertension according to the size of the left atria diameter（ normal left ventricular） were divided into left atrial enlargement group（ n = 68,group A）,left atria normal group（ n = 52,group B） and normal healthy control group（ n = 50,group C） and in the left ventricular long-axis view,the application of M type echocardiography for left ventricular ejection fraction（ LVEF）. Application spectrum Doppler（ PW） for mitral valve mouth peak early diastolic blood flow velocity,E application tissue doppler mitral peak early diastolic blood flow velocity and calculate the E / E＇.And carotid artery function parameters in WI technology： W1,W2,NA,PWVβ,β,Ep,AC. Results（ 1） Compared with normal group（ group C）,LVEF,E/E ＇,W1,NA,PWVβ,β and Ep were significantly increased and W2,AC decreased in essential hypertension group（ all P〈0. 05）.（ 2）Compared with group B,group A＇ s LVEF,E / E ＇,W1,NA were increased and W2,AC was decreased,with statistical significance（ all P〈0. 05）. EF was positively related with W1（ r = 0. 667,P〈0. 01）,E / E＇ and negatively correlated with W2（ r =- 0. 584,P〈0. 01）. Conclusions WI can evaluate the relationship between carotid artery elasticity and left ventricular function and structure change in patients with essential hypertension. In essential hypertension with left atrial enlargement,WI technology can obviously showed left ventricular diastolic dysfunction and carotid artery elasticity was decreased.