高血压患者动态血压变异性与心室重构的相关性临床研究

Relationship between Ambulatory Blood Pressure Variability and Left Ventricular Remodeling in Patients with Essential Hypertension

目的探讨高血压患者动态血压变异性(BPV)与心室重构的关系。方法选择2014年2月至2016年8月初诊为高血压的患者240例,行24h动态血压监测(ABPM)。按照左室构型类型划分将患者分为4组,即正常左室构型组、向心性重构组、向心性肥厚组和离心性肥厚组,各组60例,并设立健康对照组50例进行比较。采用超声心动图检查测定受试者LVDd(左室舒张末期内径)、LVPWT(左室后壁厚度)、IVST(室间隔壁厚度),同时计算LVMI(左室质量指数),并比较组间差异。结果与对照组比较,高血压病组BPV值增大(P<0.05);向心性肥厚组和离心性肥厚组BPV值又明显高于正常构型组和向心性重构组(P<0.05);与高血压其他组比较,离心性肥厚组BPV值增大(P<0.05)。向心性重构组、向心性肥厚组和离心性肥厚组LVDd、LVPWT、IVST与LVMI均显著高于正常左室构型组(P<0.05)。24h收缩压BPV值与LVMI呈正相关(r=0.680,P<0.05)。结论高血压患者动态血压变异性大者心室重构更显著。

Objective To investigate the relationship between ambulatory blood pressure varia- bility（BPV） and left ventricular remodeling in patients with essential hypertension. Methods A total of 240 patients preliminarily diagnosed as having hypertension between February 2014 and August 2016 underwent ambulatory blood pressure monitoring （ABPM）. These patients were di-vided into four groups：normal left ventricle configuration group, concentric configuration group, concentric hypertrophy group and eccentric hypertrophy group,with 60 patients in each group. In addition,50 healthy subjects were selected as the control group. The left ventricular end diastolic diameter（LVDd） , left ventricular posterior wall thickness （LVPWT） and interventricular septal thickness （I VST） were measured by echocardiography. Furthermore, left ventricular mass index （LVMI） was calculated. Results Compared with healthy su b je c ts , th e BPV increased in patients with hypertension（P〈0 . 05）. Compared with normal left ventricle configuration group and con-centric configuration group,the BPV increased in concentric hypertrophy group and eccentric hy-pertrophy group（P〈0 . 05）. Compared with eccentric hypertrophy group, the BPV decreased in normal left ventricle configuration group, concentric configuration group and concentric hypertro-phy group（P 〈0. 05）. Compared with normal left ventricle configuration group,the LVDd,LVP- WT,IVST and LVMI increased in concentric configuration group, eccentric hypertrophy group and concentric hypertrophy group（P 〈0. 05）. The BPV of 24-hour systolic pressure was positive-ly correlated with the LVMI（r = 0. 680,P 〈0. 05）. Conclusion The BPV is positively associated with the ventricular remodeling in patients with hypertension.