难治性高血压左心室肥厚与交感神经兴奋性关系的临床研究

Relationship between sympathetic nerve excitability and left ventricular hypertrophy in patients with refractory hypertension

目的:探讨难治性高血压患者左心室肥厚(LVH)与交感神经兴奋性之间的关系。方法:选取2014年1月至2015年6月就诊的200例难治性高血压患者,超声心动图测量室间隔厚度、左心室后壁厚度、左心室心肌质量、左心室质量指数等LVH相关指标,根据心脏超声结果分为不伴LVH组(不伴有LVH的难治性高血压患者,n=90)和LVH组(伴有LVH的难治性高血压患者,n=110)。根据24 h动态心电图结果计算平均心率、心率变异性时域指标和心率变异三角指数等交感神经兴奋性相关指标,比较两组平均心率和心率变异性。结果:与不伴LVH组相比,LVH组超声心动图LVH相关指标和平均心率均明显升高(P均<0.05),心率变异性时域指标和心率变异三角指数明显降低(P均<0.05)。结论:难治性高血压患者中,伴有左心室肥厚者交感神经兴奋性增强。

Objective： To evaluate the relationship between sympathetic nerve excitability and left ventricular hypertrophy （LVH） in patients with refractory hypertension （RH）. Methods.. Two hundred patients diagnosed with RH were selected from Janurary 2014 to June 2015. Echocardiography were used to analyzed interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass and left ventricular mass index. According to the echocardiographic findings, patients were divided into without LVH group （the RH patients without LVH, n = 90） and LVH group （the RH patients with LVH, n = 110） . Mean heart rate, time domain heart rate variability （HRV） values and HRV triangular index were obtained from 24-hour dynamic electrocardionram recordings and compared between the two groups. Results： Compared with the without LVH group, the echocardiographic indexs and mean heart rate were significantly higher in the LVH group （all P〈0. 05）, and the time domain HRV values and HRV triangular index were significantly lower （all P〈0. 05）. Conclusion： The sympathetic nerve excitability is enhanced in refractory hypertensive patients with left ventricular hypertrophy.