针刺对高血压患者左室构型及心功能的影响

Effect of acupuncture on left ventricular configuration and cardiac function in patients with hypertension

目的:观察轻中度高血压患者左室构型的相关影响因素,评价针刺对左室构型及心室功能的影响。方法:对符合纳入标准的200例轻中度高血压患者,采用石学敏院士"活血散风"针刺法,穴取人迎、曲池、合谷、足三里、太冲、每日1次,每周5次,共针刺3个月。治疗前测量患者血压并检测血脂水平;分别于治疗前及治疗结束后3个月进行心脏彩超检查,测量舒张末期左室内径(LVIDd)、舒张末期左室后壁厚度(LVPWTd)和舒张末期室间隔厚度(IVSTd)、射血分数(EF)、左室质量指数(LVMI)等;分析不同左室构型的相关影响因素。结果:轻中度高血压患者中出现左室构型异常(向心性重构、向心性肥厚、离心性肥厚)者达到60%。离心性肥厚组与正常构型组、向心性重构组比较,在夜间平均脉压、总胆固醇、BMI、腰围方面差异有统计学意义(P<0.05);LVMI与夜间脉压、腰围、总胆固醇、BMI相关(P<0.05),左室相对室壁厚度与总胆固醇、BMI和腰围相关(P<0.05)。正常构型到向心性重构、向心性肥厚、离心性肥厚的舒张功能有逐渐减低的趋势,但差异无统计学意义(P>0.05);向心性肥厚组、离心性肥厚组收缩功能明显低于正常构型组和向心性重构组(P<0.05)。针刺前后左心室收缩功能、舒张功能比较差异无统计学意义(P>0.05)。结论:有60%轻中度高血压患者出现左室构型异常,并与总胆固醇、BMI、腰围、夜间平均脉压相关。目前研究尚未发现针刺对左室构型及左心功能有明显改善作用。

Objective To observe the related factors of left ventricular configuration in patients with mild to moderate hypertension, and to evaluate the influence of acupuncture on left ventricular configuration and cardiac function. Methods Huoxue Sanfeng acupuncture regime formulated by academician SHI Xue-min was applied to 200 patients with mild to moderate hypertension. The treatment was given once a day, 5 times a week for 3 months. Blood pressure and blood lipid levels were measured before treatment. Before treatment and 3 months after treatment, the echocardiography was used to measured end-diastolic left ventricular diameter(LVIDd), end-diastolic left ventricular posterior wall thickness(LVPWTd), and end-diastolic interventricular septum thickness(IVSTd), ejection fraction(EF), left ventricular mass index(LVMI), etc.;the relevant influencing factors of different left ventricular configurations were analyzed. Results The patients with mild to moderate hypertension had left ventricular dysplasia(left ventricular remodeling, concentric hypertrophy, eccentric hypertrophy) reached 60%, and compared with the normal configuration group and the left ventricular remodeling group, there were significant differences in nighttime mean pulse pressure, total cholesterol, BMI and waist circumference in the eccentric hypertrophy group(P<0.05). LVMI was associated with nighttime pulse pressure, waist circumference, total cholesterol and BMI(P<0.05). Left ventricular relative wall thickness was associated with total cholesterol, BMI and waist circumference(P<0.05). The diastolic function from normal configuration to left ventricular remodeling, concentric hypertrophy and eccentric hypertrophy gradually decreased, but there were no significant difference(P>0.05). The systolic function in the concentric hypertrophy group and the eccentric hypertrophy group was significantly lower than that in the normal configuration group and the left ventricular remodeling group(P<0.05). There was no significant difference in left ventricular systolic function and diastolic function before and after acupuncture(P>0.05). Conclusion Sixty percents of patients with mild to moderate hypertension have abnormal left ventricular configuration and are associated with total cholesterol, BMI, waist circumference and nighttime mean pulse pressure. Studies have not found that acupuncture can significantly improve the left ventricular configuration and left cardiac function.