左心室肥厚与脑血流动力学变化及脑卒中发病风险的关系

Relationship of left ventricular hypertrophy with cerebrovascular hemodynamic index and risk factors for ischemic stroke

目的探讨心电图定义的左心室肥厚(LVH)与脑血流动力学指数(CVHI)变化及脑卒中发病风险的关系。方法从上海市奉贤区某镇脑血管病危险因素队列研究人群中,选择年龄≥65岁的调查者1720例,并分为LVH组101例和对照组1619例,对2组基线调查过程中收集的危险因素、LVH、CVHI等信息及其与脑卒中发病风险的关系进行分析。结果 LVH组和对照组CVHI分别为(56.83±32.01)分和(72.17±29.52)分,CVHI<75分的比例分别为66.3%和42.4%,改良Framingham卒中风险(FSP)评分分别为(17.22±4.12)分和(11.03±3.65)分,2组比较均有统计学差异(P<0.01)。LVH组除左侧最大流速外,右侧最大流速、双侧平均血流量、最小流速、平均流速等显著低于对照组(P<0.05),双侧外周阻力、脉搏波速等显著高于对照组(P<0.05)。LVH、CVHI和FSP评分预测脑卒中发病风险的相对危险度分别为1.69(95%CI:0.76~3.73)、3.17(95%CI:1.81~5.54)和1.35(95%CI:0.67~2.71)。控制年龄、性别及3个预测因素间的相互影响后,仅CVHI为脑卒中的独立预测因素。结论LVH有可能导致CVHI明显异常,CVHI是脑卒中的独立预测因素。

Objective To study the relationship of ECG-defined left ventricular hypertrophy（LVH）with cerebrovascular hemodynamic index（CVHI）and risk facrors for ischemic stroke.Methods A total of 1720 subjects with their age≥65 years from a cerebrovascular disease cohort in Fengxian District of Shanghai City were divided into LVH group（n=101）and control group（n=1619）.Relationship of LVH,CVHI and Framingham stroke profile（FSP）score with risk factors for ischemic stroke were analyzed.Results The CVHI score was 56.83±32.01 and 72.17±29.52 respectively and the modified FSP score was 17.22±4.12 and 11.03±3.65 respectively in LVH group（P〈0.01）.The cerebral blood velocity and volume were significantly lower while the peripheral resistance and pulse wave velocity were significantly higher in LVH group than in control group（P〈0.05）.The relative risk of LVH,CVHI and FSP score in predicting ischemic stroke was 1.69（95%CI：0.76-3.73）,3.17（95%CI：1.81-5.54）and 1.35（95%CI：0.67-2.71）respectively.The CVHI score was an independent risk factor for ischemic stroke when the mutual influence of age,sex,and LVH,CVHI,FSP score on ischemic stroke was controlled.Conclusion LVH-related CVHI is an independent risk factor for ischemic stroke.