原发性高血压合并慢性心力衰竭患者心脏结构改变及危险因素分析

Risk factors analysis of cardiac structural changes in essential hypertension patients with chronic heart failure

目的分析原发性高血压合并慢性心力衰竭患者心脏结构改变及其影响因素。方法选取2015年10月一2016年9月青海省人民医院心血管内科收治的原发性高血压合并慢性心力衰竭患者92例为观察组,同期NYHA分级Ⅰ级单纯高血压患者84例为对照组,比较分析2组患者心脏结构差异,并分析影响因素。结果观察组左室左右径较对照组明显增加(t=6.310,P<0.01),左室上下径差异无明显区别(t=1.851,P=0.071),左房左右径、上下径及左房内径(LAD)均比对照组明显增加(t=3.548,8.722,6.779,P<0.01),LVEF明显低于对照组(t=3.052,P=0.002);观察组LVM、LVEDV及LVESV明显大于对照组(t=6.122、4.853、6.733,P均<0.01);2组患者IVST、LVPWT无明显差异(t=0.187、0.499,P=0.852、0.618);观察组LVSI明显大于对照组,更趋向于球形(t=3.343,P=0.001);LASI明显小于对照组,左房形态偏离球形(t=3.199,P=0.002)。经多元回归分析显示,年龄、腰臀比、心功能Ⅳ级是影响患者心脏结构改变的危险因素(OR=1.716,95%CI 1.112~3.148,P=0.013;OR=1.715,95%CI 1.163~4.329,P=0.009;OR=1.609,95%CI 1.019~3.726,P=0.004)。结论原发性高血压合并慢性心力衰竭患者比单纯高血压病患者心脏构型改变更显著,其显著受患者年龄、腰臀比及心功能Ⅳ级等因素影响。

Objective To investigate the cardiac structural changes in essential hypertension patients with chronic heart failure, and to analyze the influencing factors.Methods Ninety-two cases of essential hypertension patients with chronic heart failure in the hospital from October 2015 to September 2016 were collected as observation group,84 cases of essential hypertension patients were collected as control group.Cardiac structural differences of patients in two groups were compared, and influential factors were analyzed.Results The transverse diameters of left ventricle of patients in observation group were significantly higher than control group （P 〈0.05）.There was no significant difference in vertical diameter of left ventricle in two groups （P 〉0.05）.Transverse diameters and vertical diameters of left atrium and left atrial diameters（LAD）of patients in observation group were significantly higher than control group （P 〈0.05）.LVEF of patients in observation group were lower than control group （P 〈0.05）, LVM, LVEDV and LVESV of patients in observation group were significantly higher than control group （P 〈0.05）;IVST and LVPWT of patients in two groups had no significant differences （P 〉0.05）;LVSI of patients in observation group was significantly higher than control group （P 〈0.05）, and the former were more tend to spherical.LASI of patients in observation group were significantly smaller than control group, left atrial shape of patients in observation group were deviated from spherical （P 〈0.05）.Multiple regression analysis showed that age, waist to hip ratio, and cardiac function were the risk factors for cardiac structural changes （OR =1.716, 95% CI 0.002-3.148, P =0.013;OR =1.715, 95% CI 1.163-4.329, P =0.009;OR =1.609, 95% CI 1.019-3.726, P=0.004）.Conclusion The changes of cardiac configuration in essential hypertension patients with chronic heart failure were more significant than essential hypertension patients, and the changes were influenced by age, waist to hip ratio and heart function of gradeⅣ.