高血压患者血同型半胱氨酸与左心室舒张功能和收缩同步性的关系

Homocysteine,Left Ventricular Systolic Dyssynchrony and Diastolic Dysfunction in Hypertensive Patients

目的探讨H型高血压患者的同型半胱氨酸（Hey）与左心室同步性的关系。方法选取2015年4～12月天津医科大学第二医院诊断为原发性高血压并高Hey（Hey〉15μmol／L）患者79例。按二尖瓣血流频谱舒张早期E峰与二尖瓣环组织频谱舒张早期e峰比值（E／e）分为D1组（E／e≤15，n=39），D2组（E／e〉15，n=40）。选取同期入院Hey正常的高血压患者39例作为对照组。测量室间隔厚度（IVST）、左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVDs）、左心室后壁厚度（LvPwT）、左心房内径收缩期前后径（LAD），计算左心室质量指数（LVMI）和射血分数（EF）。测二尖瓣血流频谱E峰与二尖瓣舒张晚期A峰比值（E／A）、E／e，并计算Tei指数。三维超声测左心房容积（LAV）并计算左心房容积指数（LAVI）。测量心电图QRS波起点距左心室16节段达收缩最小容积点时间间隔的标准差心率校正标准化值[Tmsvl6-SD（R-R％）]。检测血清中Hey浓度及空腹血糖（FBG）。结果D2组Hey水平显著高于D1组及对照组[（22．3±4．1）μmol／L比（19．5±2．8）μmol／L、（9．5±3．10）μmol／L，P〈0．05]，D1组Hey水平高于对照组（P〈0．05）。D2组FBG显著高于D1组及对照组[（6．2±1．6）mmol／L比（5．6±1．1）mmol／L、（5．5±0．9）mmol／L，P〈0．05]，D1组与对照组比较差异无统计学意义（P〉0．05）。D2组Tmsv16-SD（R—R％）显著高于D1组和对照组[（4．07±2．60）％比（1．64±0．85）％、（1．72±1．14）％，P〈0．05]。D2组D2组LAVI较D1组、对照组显著增高[（29．7±3．2）mL／m^2比（27．3±2．9）mL／m^2、（22．1±3．6）mL／m^2，P〈0．05]，D1组LAVI较对照组明显增高（P〈0．05）。D2组ni指数较D1组和对照组显著增高[（0．56±0．16）比（0．48±0．17）、（0．46±0．08），P〈0．05]，D1组与对照组比较差异无统计学意义（P〉0．05）。Hey与Tmsv16·SD（R—R％）呈正相关（r=0．289，P〈0．001）。结论E／e〉15的H型高血压患者左心室收缩同步性下降，且与Hey浓度呈正相关。H型高血压患者左心室舒张功能较普通高血压患者更差。

Objective To explore relationship between homocysteine （Hcy） and left ventricular dyssyn- chrony in H-type hypertensive patients. Methods Total of 79 patients diagnosed primary hypertension and hyperhomocysteinemia（ Hcy 〉 15μmoL/L） admitted to the Second Hospital of Tianjin Medical University between Apr. 2015 and Dee. 2015 were enrolled in the study. According to the ratio of the trans-mitral early peak diastolic velocity （E） to the early diastolic mitral annulus velocity （e） （E/e） ,patients were divided into two groups： D1 group （ E/e ≤ 15, n = 39 ） and D2 group （ E/e 〉 15, n = 40 ）. 39 patients with hypertension and normal Hey during the same period were enrolled as a control group. The interventricular septum thickness （IVST） , left ventricular end-diastolic diameter （LVDd） , left ventricular end-systolic diameter （LVDs） , left ventricular posterior wall thickness （LVPWT） , left atrial systolic diameter （LAD） were measured by using eehocardiography. Left ventricular mass index （LVMI） and ejection fraction （EF） were calculated. The E/A ratio, E/e ratio were measured,and the Tei index was calculated. The left atrial volume（LAV） was measured by using three-dimensional echocardiography and left atrial volume index （LAVI） was calculated. LV dyssyn- chrony was assessed by using three dimensional echo imaging （3DE） , represented by Tmsvl6-SD （R-R%） , meaning the standard deviation of the differences in time intervals to peak systolic volumes in 16 myocardial segments and standardized by R-R interval. Hcy concentration and fasting blood glucose （FBG） were tested. Results Hcy level in the 1）2 group was significantly higher than the D1 group and control group [ （22. 3 ± 4. 1 ） μmol/L vs （ 19.5±2. 8 ） μmol/L , （9. 5 ± 3.1 ） μmol/L, P 〈 0.05 ] , Hey level in the D1 group was significantly higher than the control group （ P 〈 0. 05 ）. FBG in the D2 group was significantly higher than the D1 group and control group E （ 6. 2 ± 1.6 ） mmol/L vs （ 5.6 ± 1.1 ） mmol/L, （ 5.5 ±0. 9 ） mmol/L, P 〈 0. 05 ]. No significant difference was found between D1 group and control group. Tmsvl6-SD（ R-R % ） in the D2 group was significantly higher than the D1 group and control group [ （4. 07 ± 2. 6） % vs （ 1.64 ± 0. 85 ） %, （ 1.72 ± 1.14） %, P 〈 0. 05 ]. LAVI in the D2 group was significantly higher than the D1 group and control group [（29.7 ±3.2） mL/m^2 vs （27.3 ±2.9） mL/m^2,（22. 1 ±3.6） mL/m^2, P〈0.05], LAVI in the DI group was significantly higher than the control group （ P 〈 0. 05 ）. Tel index in the D2 group was signiftcanfly higher than theD1 group and control group [（0.56 ±0.16） vs （0.48 ± 0.17）, （0.46 ±0.08）, P〈 0. 05 ] , while there was no significantly difference between the D1 group and control group （ P 〉 0. 05 ）. Hey was positively correlated with Tmsv16-SD（R-R% ） （r=0. 289, P 〈0. 001 ）. Conclusion Patients with E/e ratio 〉 15 in H-type hypertension have left ventricular dyssynchrony, which is positively associated with Hey concentration. Diastolic dysfunction of patients with H-type hypertension is worse than patients with normal type hypertension.