高血压心肌重构与心电图V1导联P波终末电势的相关性

Correlation Between Myocardial Remodeling in Systemic Hypertension and P-wave Terminal Force in Lead V1

目的分析高血压心肌重构与心电图V1导联P波终末电势（PTFV1）的相关性。方法选取我院诊治的高血压心肌重构患者90例为研究对象，均行心电图检查，将心电图上PTFV1值≤-40mm·s者60例纳入观察组，PTFV1〉-40mm·s者30例纳入对照组，记录两组超声心动图上左房内径（LAD）、左室舒张期直径（LVDD）、左室等容舒张时间（LVRT）、左心室射血分数（LVEF）及二尖瓣舒张早期流速峰值／二尖瓣舒张晚期流速峰值（E／A），对比两组血清超敏c反应蛋白（hs—CRP）、N末端B型利钠肽（NT—proBNP）、血管紧张素（1—7）[Ang（1—7）]、血管紧张素Ⅱ（Ang11）水平及心律失常发生率，并分析患者PTFV1绝对值与上述心功能指标、血清学指标相关性。结果观察组LAD（43．19±3．19）mm、LVDD（49．21±1．85）mm、LVRT（98．15±1．48）ms大于对照组（P〈0．05），观察组LVEF（43．11±1．05）％、E／A值（0．84±0．27）较对照组低（均P〈0．05）；观察组血清hs—CRP（13．29±1．67）mg／L、NT—proBNP（85．39±1．68）pg／ml、AngⅡ水平（43．29±1．06）ng／ml与对照组比较明显较高（P〈0．05），而观察组Ang（1—7）（1．02±0．41）ng／ml水平低于对照组（P〈0．05）；观察组房性早搏、室性早搏、阵发房扑、阵发房颤等心律失常发生率35．00％高于对照组13．33％（P〈0．05）；相关分析显示PTFV1绝对值与其LAD、LVDD、LVRT及血清hs—CRP、NT—proBNP、AngⅡ水平呈正相关，与LVEF、E／A值及血清Ang（1—7）水平呈负相关（P〈0．05）。结论高血压心肌重构后心功能指标及血清hs—CRP、NT—proBNP、AngⅡ、Ang（1—7）水平与心电图PTFV1绝对值具有一定相关性，临床需加以监测。

Objective To analyze the correlation between myocardial remodeling in hypertension and P- wave terminal force in lead V1 （PTFV1）. Methods 90 patients with hypertensive myocardial remodeling were selected. Electrocardiography （ECG） was performed in all patients. The patients were divided into the observation group （60 cases with PTFV1 ≤ -40mm ·s） and the control group （30 cases with PTFV1〉 -40mm ·s ）. The left atrial diameter （LAD）, left ventrieular diastolic diameter （LVDD） , isovolumic relaxation time （LVRT） , left ventricular ejection fraction （LVEF） and early diastolic peak velocity of mitral valve/advanced diastolic peak velocity of mitral valve （E/A） in two groups were recorded. Serum levels of high - sensitivity C - reactive protein （hs-CRP）, N-terminal pro-brain natriuretic peptide （NT-proBNP）, angiotensin （1-7） [Ang （1-7）] and angiotensin Ⅱ （ Ang Ⅱ ） and the incidence of arrhythmia were compared between the two groups. Results LAD, LVDD and LVRT in the observation group were greater than those in the control group, while LVEF and E/A were lower than those in the control group （P 〈0. 05 ）. The levels of hs - CRP, NT - proBNP and Ang Ⅱ were significantly higher in the observation group than those in the control group （ P 〈0. 05 ）, while Ang （ 1 - 7 ） level was lower than that in the control group （ P 〈0. 05 ）. The incidence of atrial premature beats, ventricular premature beats, paroxysmal atrial flutter and paroxysmal atrial fibrillation in the observation group were higher than those in the control group （35.00% vs 13.33% ） （P 〈0. 05）. Correlation analysis showed that the absolute value of PTFV1 was positively correlated with LAD, LVDD, LVRT, hs - CRP, NT - proBNP and Ang Ⅱ, and negatively correlated with LVEF, E/A and Ang （ 1 - 7） （P 〈 0. 05）. Conclusion There is a certain correlation between cardiac function index, the levels of serum hs - CRP, NT - proBNP, Ang Ⅱ, Ang （ 1 - 7） and the absolute value of PTFV1 in hypertensive patients with myocardial remodeling.