低盐饮食对高血压合并舒张性心力衰竭患者心室舒张功能的影响

Effect of Low-Sodium Diet on Ventricular Diastolic Function in Patients with Hypertensive Heart Disease

目的评估低盐饮食是否可改善高血压合并舒张性心力衰竭患者心室舒张功能。方法采用前瞻性队列前后对照方法,对符合纳入标准的高血压合并舒张性心力衰竭患者予严格的限盐策略,随访1个月,行心脏彩超评估患者等容舒张时间、二尖瓣舒张早期流速(A峰)、二尖瓣舒张晚期流速(E峰)、A/E峰比值。结果共47例患者完成随访。干预前与干预后比较:诊室血压差异有统计学意义[(165±25)mmHg比(134±19)mmHg,P=0.04];动态血压[(140±30)mmHg比(128±18)mmHg,P=0.28)]、左室舒张末期容量[(98±23)mL比(97±22)mL,P=0.68]、射血分数[(65±17)%比(69±14)%,P=0.15]、二尖瓣A峰流速[(79±14)cm·s-1比(83±17)cm·s-1,P=0.25]、二尖瓣E峰流速[(92±29)cm·s-1比(84±20)cm·s-1,P=0.20]、二尖瓣E/A峰比值[(1.13±0.31)比(0.98±0.14),P=0.14],差异均无统计学意义。结论高血压合并舒张性心力衰竭患者严格的限盐策略对降低诊室血压水平有益,但对心室舒张功能未见明显改善。

Objective To assess whether low-sodium diet improves the ventricular diastolic function in patients with hypertensive heart disease. Methods A prospective cohort design was used in this study.Strict salt restriction was performed in patients with hypertension and diastolic dysfunction who met the inclusion criteria.Patients were followed up for 1 month.The isovolumic relaxation time,mitral flow velocity in early diastole（peak A）,mitral flow velocity in late diastole（peak E） and A/E ratio were determined by color Doppler echocardiography. Results A total of 47 patients completed the follow-up.The clinic blood pressure measured before intervention was markedly higher than that measured after intervention（（165±25） mmHg vs（134±19） mmHg, P = 0.04）.However,no significant changes were found in a mbulatory blood pressure（（140±30）mmHg vs（128±18） mmHg, P =0.28）,left ventricular end-diastolic volume（（98±23） mL vs（97±22）mL, P =0.68）,ejection fraction（（65±17）% vs（69±14）%, P =0.15）,peak A velocity（（79±14） cm·s^-1 vs（83±17） cm·s^-1 , P =0.25）,peak E velocity（（92±29） cm·s^-1 vs（84±20） cm·s^-1 , P =0.20）,and E/A ratio（1.13±0.31 vs 0.98±0.14, P =0.14）. Conclusion The strict salt restriction is beneficial for lowering clinic blood pressure,but cannot improve ventricular diastolic function in patients with hypertensive heart disease.