老年轻、中度原发性高血压患者左心室舒张功能与自主神经功能的关系

Relationship between left ventricular diastolic function and autonomic nervous function in elderly patients with mild-to-moderate essential hypertension

目的 探讨老年轻、中度原发性高血压患者左心室舒张功能与自主神经功能的关系.方法 纳入老年轻、中度原发性高血压患者146例,采用超声心动图检测患者左心室舒张功能和常规指标,依据左心室舒张功能将其分为舒张功能正常组72例和舒张功能减退组74例.采用24 h动态心电图监测两组患者反映自主神经功能的心率变异性时域指标;采用酶联免疫吸附试验（ELISA）检测其血浆氨基末端脑钠尿肽前体（NT-proBNP）水平并进行比较分析.结果 舒张功能减退组NT-proBNP水平、左心室质量指数（LVMI）、室间隔厚度（IVST）及左心室舒张末期后壁厚度（LVPWT）均高于舒张功能正常组,而所有心脏搏动RR间期的标准差（SDNN）、所有心脏搏动RR间期之差的均方根（rMSSD）、所有5min心脏搏动RR间期均值的标准差（SDANN）及所有差值超过50 ms连续RR间期个数占总数的百分比（pNN50）均低于舒张功能正常组（P〈0.05）,两组间三角指数、左心房内径（LAD）及左心室射血分数（LVEF）比较差异均无统计学意义（P〉0.05）.偏相关分析结果显示,A峰与三角指数、rMSSD及pNN50呈负相关（r=-0.211,-0.208,-0.219,P均〈0.05）;E/A与三角指数、rMSSD及pNN50均呈正相关（r=0.181,0.182,0.179,P均〈0.05）;E＇与SDNN呈正相关（r=0.178,P〈0.05）;E/E＇、lnNT-proBNP与SDNN呈负相关（r=-0.181,-0.183,P均〈0.05）.多元逐步回归分析结果显示,E/E＇和lnNT-proBNP是SDNN的独立影响因素,A峰和E/A是pNN50的独立影响因素（P〈0.05）.结论 老年轻、中度原发性高血压患者的左心室舒张功能减退与自主神经功能损伤相关.

Objective To explore the relationship between left ventricular diastolic function and autonomic nervous function in elderly patients with mild-to-moderate essential hypertension. Methods A total of 146 elderly patients with mild-to-moderate essential hypertension were included. Left ventricular diastolic function and conventional indexes in all patients were measured by echocardiography. According to left ventricular diastolic function, they were divided into normal diastolic function group（72 cases） and diastolic dysfunction group （74 cases）. HRV time domain indexes which reflected autonomic function in two groups were monitored by 24 h dynamic electrocardiogram. Levels of plasma NT-proBNP were detected by ELISA and compared between two groups. Results Level of NT-proBNP, LVMI, IVST and LVPWT in diastolic dysfunction group were higher than those in normal diastolic function group, but SDNN, root mean square of the difference between all adjacent RR intervals （ RMSDD ）, the standard deviation of all 5min heart beat RR intervals（SDANN） and the percent of adjacent RR interval with time difference 〉50 ms among all RR intervals （ pNNS0 ） were lower than those in normal diastolic function group （ P 〈 0.05 ）. There were no significant differences in the triangle index, LAD and LVEF between two groups （P 〉 0.05 ）. Partial correlation analysis showed that A peak was negatively correlated with triangular index, rMSSD and pNN50 （ r = - 0. 211, - 0. 208, - 0. 219, P 〈 0. 05 ）. E/A was positively correlated with triangular index, rMSSD and pNN50 （ r = 0. 181,0. 182,0. 179, P 〈 0. 05 ）. E＇ was positively correlated with SDNN （ r = 0. 178 ,P 〈 0.05 ）. E/E＇ and lnNT-proBNP were negatively correlated with SDNN （ r = - 0. 181, -0. 183,P 〈 0.05 ）. Multiple stepwise regression analysis showed that E/E＇ and lnNT-proBNP were independent influencing factors of SDNN, A peak and E/A were independent influencing factors of pNN50 （ P 〈0. 05 ）. Conclusion Left ventricular diastolic dysfunction in elderly patients with mild-to-moderate essential hypertension is associated with autonomic nervous dysfunction.