H型高血压与左心室重构的关系探讨

Discussion on the relationship between H-type hypertension and left ventricular remodeling

目的探讨高同型半胱氨酸血症(HHcy)与高血压对左心室重构的发生的影响及其与严重程度是否存在协同作用。方法选取因冠心病就诊患者275例,根据血压及同型半胱氨酸(Hcy)水平将患者分为4组:H型高血压组96例,非H型高血压组44例,高Hcy(HHcy)非高血压组53例,对照组65例。分析比较各组患者空腹血糖(Glu)、血浆总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等生化指标,观察左心室收缩末期内径(LVESD)、左心室舒张末器内径(LVEDD)、左室后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室质量指数(LVMI)、左心室壁相对厚度等超声指标以及发生左心室重构的患者比例。分析左心室重构的影响因素。结果 4组的生化指标除Hcy水平外,其余生化指标差异均无统计学意义。各组LVMI、左心室壁相对厚度及发生左心室重构的比例均为H型高血压组高于其他3组(均P<0.05)。Hcy水平与LVMI、左心室壁相对厚度呈正相关。Logistic回归分析示,患有HHcy、高血压及两者共存(OR分别为7.443、7.754及9.948,P<0.05)为左心室重构的危险因素,高血压与HHcy两者共存时风险性高于单纯HHcy及单纯高血压者。结论 HHcy和高血压是导致左室重构的危险因素,HHcy与高血压共存时对左心室重构的发生及严重程度存在协同作用。

Objective To investigate the effects of homocysteinemia（HHcy） and hypertension on left ventricular re-modeling. Methods A total of 275 patients with coronary heart disease were divided into four groups including H-type hypertension group（n=96）, non-H-type hypertension group（n=44）, HHcy＋non-hypertension group（n=53） and control group（n=65） based on their blood pression levels and plasma HHcy levels. The serum levels of glucose（Glu）, total cholesterol（TC）, triglyceride（TG）, low density lipoprotein（LDL） and high-density lipoprotein（HDL） were compared between groups.The left ventricular end systolic diameter（LVESD）, left ventricular end diastolic diameter（LVEDD）, left ventricular posterior wall thickness（LVPWT）, ventricular septal thickness（IVST） and left ventricular mass index（LVMI） were observed in four groups. The proportion of patients with left ventricular remodeling was also compared between four groups. The influence factors of left ventricular remodeling were analysed. Results There were no significant differences in biochemical parameters except Hcy level between frour groups. The values of LVMI, left ventricular wall thickness and the proportion of patients with left ventricular remodeling were significantly higher in H-type hypertension group than those of other three groups（P〈0.05）. The Hcy level was positively correlated with LVMI and left ventricular wall thickness. Logistic regression analysis showed that HHcy and hypertension were the risk factors of left ventricular remodeling（OR=7.443, 7.754 and 9.948,P〈0.05）. The risk factors of left ventricular remodeling were higher in patients with both HHcy and hypertension than those in patients with HHcy or hypertension. Conclusion Homocysteine and higher systolic pressure are independent risk factors for left ventricular remodeling and they have a synergistic effect on leading to left ventricular remodeling.