高血压病人左室肥厚与心脏结构及功能的关系

The Sequential Changes of Cardiac Function and Structure in Relationship to Left Ventricular Hypertrophy

研究138例原发性高血压病人M型超声心动图测定的左室重量指数(LVMI)与收缩末期左室容积(ESV)、收缩末期左室壁张力(ESS)、舒张末期左室容积(EDV)、收缩压(SBP)/ESV关系,与健康人(181例)进行对照。健康男性LVMI上界为100g/m^2,女性为90g/m^2,高血压病人LVMI即使在正常范围,其他各种参数已有明显变化。LVMI达140g/m^2后,EDV,ESS,平均动脉血压(MBP)明显增加,SBP/ESW与左室内径缩短率(FS)明显下降。LVMI 140g/m^2可能是机体对高血压从适应向代偿转变的转折点。LVMI与MBP,EDV,ESS呈正相关,与心脏收缩指数呈负相关。多因素分析表明前负荷(EDV)与后负荷(ESS)是LVMI的两项主要因素。

Left ventricular mass index (LVMI) determined by echocardiography was correlated to ESV, ESS, EDV, BP/ESV and FS in 138 cases of essential hypertension with 181 healthy subjects as controls. It was found that the normal upper limit of LVMI in the Chinese male is 100 g/m^2 and in the female 90g/ m^2. Although the LVMI remained in the mormal range, Various parameters underwent remarkable changes. After LVMI reached 140g/m^2, EDV, ESS and MBP increased sharply, while BP/ESV and FS decreased markedly. LVMI of 140g/m^2 may be the critical point in the response of the organism to hypertension, moving from adaptation to decompensation. LVMI was closely related to MBP, EDV and ESS (r=0. 71, 0. 74, and 0. 66, respectively). LVMI was inversely related to the indexes of cardiac contractility, BP/ESV, and FS (r=- 0. 68 and -0. 7). Multivariate analysis of determinants of LVMI showed that preload (EDV) and afterload (ESS) were the two major components. Decreased preload has at least the same significance in the regression of left ventricular hypertrophy by pharmaceutical treatment.