Hepcidin-25 negatively predicts left ventricular mass index in chronic kidney disease patients

AIM： To assess the correlation between the serum hep-cidin-25 level and left ventricular mass index.METHODS： This study was a cross-sectional study conducted between March 2009 and April 2010. Demo-graphic and biochemical data, including the serum hep-cidin-25 level, were collected for chronic kidney disease （CKD） patients. Two-dimensional echocardiography was performed to determine the left ventricle mass （LVM）, left ventricular mass index （LVMI）, interventricular septum thickness （IVSd）, left ventricle posterior wall thickness （LVPW）, right ventricular dimension （RVD）, left atrium （LA） and ejection fraction （EF）.RESULTS： A total of 146 patients with stage 1 to 5 CKD were enrolled. Serum hepcidin-25 levels were 16.51 ± 5.2, 17.59 ± 5.32, 17.38 ± 6.47, 19.98 ± 4.98 and 22.03 ± 4.8 ng/mL for stage 1 to 5 CKD patients, respectively. Hepcidin-25 level was independently pre-dicted by the serum ferritin level （β = 0.6, P = 0.002） and the estimated glomerular fltration rate （β = -0.48, P = 0.04）. There were negative correlations between the serum hepcidin level and the LVM and LVMI （ P = 0.04 and P = 0.005, respectively）. Systolic blood pressure （BP） was positively correlated with the LVMI （ P = 0.005）. In the multivariate analysis, a decreased serum hepci-din-25 level was independently associated with a higher LVMI （β = -0.28, 95%CI： -0.48 - -0.02, P = 0.006） after adjusting for body mass index, age and systolic BP.CONCLUSION： A lower serum hepcidin level is associ-ated with a higher LVMI in CKD patients. Low hepcidin levels may be independently correlated with unfavor-able cardiovascular outcomes in this population.

Is hepatic steatosis associated with left ventricular mass index increase in the general population?

AIM To investigate the association between hepatic steatosis and change in left ventricular mass index(LVMI) over five years, and examine whether systolic and diastolic blood pressures are mediators of the association between hepatic steatosis and LVMI using a general population sample.METHODS We analyzed data from the Study of Health in Pomerania. The study population comprised 1298individuals aged 45 to 81 years. Hepatic steatosis was defined as the presence of a hyperechogenic pattern of the liver together with elevated serum alanine transferase levels. Left ventricular mass was determined echocardiographically and indexed to height2.7. Path analyses were conducted to differentiate direct and indirect paths from hepatic steatosis to LVMI encompassing systolic and diastolic blood pressure as potential mediating variables.RESULTS Hepatic steatosis was a significant predictor for all measured echocardiographic characteristics at baseline. Path analyses revealed that the association of hepatic steatosis with LVMI change after five years was negligibly small(β =-0.12, s.e. = 0.21, P = 0.55). Systolic blood pressure at baseline was inversely associated with LVMI change(β =-0.09, s.e. = 0.03, P < 0.01), while no association between diastolic blood pressure at baseline and LVMI change was evident(β = 0.03, s.e. = 0.05, P = 0.56). The effect of the indirect path from hepatic steatosis to LVMI via systolic baseline blood pressure was small(β =-0.20, s.e. = 0.10, P = 0.07). No indirect effect was observed for the path via diastolic baseline blood pressure(β = 0.03, s.e. = 0.06, P = 0.60). Similar associations were observed in the subgroup of individuals not receiving beta-blockers, calcium channel blockers, or drugs acting on the reninangiotensin system.CONCLUSION Baseline associations between hepatic steatosis and LVMI do not extend to associations with LVMI change after five years. More studies are needed to study the longitudinal effects of hepatic steatosis on LVMI.

Correlation between IL-33/sST2 signaling pathway and patients with essential hypertensive left ventricular hypertrophy

Objective:To detect the levels of interleukin-33(IL-33)and soluble ST2(sST2)in peripheral blood of patients with essential hypertensive left ventricular hypertrophy,and to discusstheir correlation with patients with essential hypertensive left ventricular hypertrophy was further discussed.Methods:A total of 220 patients with essential hypertension treated in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Bengbu Medical College were enrolled as the experimental group.According to left ventricular mass index(LVMI),patients with essential hypertension were divided into the non-left ventricular hypertrophy group(NLVH,n=108 cases)and the left ventricular hypertrophy group(LVH,n=112 cases).We used ELISA to detect the serum levels of IL-33 and sST2,the expression levels of IL-33 in peripheral blood lymphocytes of the NLVH group and the LVH group(60 cases each)were detected by Western blot,and the relationship between IL-33 and LVMI,a marker of left ventricular hypertrophic condition,was analyzed by Pearson.The relationship between IL-33,sST2 and left ventricular hypertrophy in essential hypertension was studied.Results:Compared with the NLVH group,the expression levels of IL-33 and sST2 in the LVH group were significantly increased.The results of Western blot showed that the expression level of IL-33 in the LVH group(1.07±0.08)was higher than that in the NLVH group(0.63±0.05)(P<0.05).Pearson correlation analysis showed that IL-33 was positively correlated with LVMI,sST2 was positively correlated with LVMI.Conclusion:The levels of IL-33 and sST2 in serum and the expression levels of IL-33 protein in peripheral blood lymphocytes are significantly increased in patients with hypertensive left ventricular hypertrophy,and the occurrence and development of essential hypertensive left ventricular hypertrophy may be related to IL-33 and sST2.

Contribution of Ambulatory Pulsed Pressure in the Modification of the Left Ventricular Geometry of the African Black People

Introduction-Purpose: Pulsed pressure is recognized as an important predictor of cardiovascular risk. The purpose of this study was to identify a possible association between high ambulatory pulsed pressure and left ventricular geometry change in African black people. Material and methods: We conducted a bicentric, retrospective descriptive and analytical study that took place from 2010 to 2015 at the Abidjan Heart Institute and the Polyclinic Sainte Anne Marie in Abidjan. The people were selected from MAPA’s archive files. Those aged 18 years and over were included, all of whom had valid echocardiography and MAPA. The analyzed parameters concerned epidemiological data with age, gender and body surface area. The clinical data analyzed included systolic, diastolic, mean and 24-hours pulsed pressures. On the echocardiographic parameters, it was the evaluation of the ventricular mass indexed to the body surface. Results: A total of 177 patients records were selected. The mean age of the patients was 56.32 ± 10.51 years. There was a male predominance with a sex ratio of 1.15. The main cardiovascular risk factors found outside high blood pressure were dyslipidemia (06.87%) and obesity (13.7%). In clinical terms, hypertension was found in 75% of cases (n = 133) versus 25% (n = 44) of normotensive patients. These blood pressure profiles allowed us to classify our study population into two groups: hypertensives people and normotensives people. The hypertensives people had significantly higher mean pulsed pressure levels than the normotensives people. All normotensive patients had normal pulsed pressure. In the hypertensive population, the prevalence of high pulsed pressure was 31% (n = 41) versus 69% (n = 92) normal pulsed pressure. Concerning the relationship between 24 hour ambulatory pulsed pressure and left ventricular mass, hypertensives patients with a high ambulatory pulsed pressure had a significantly higher average indexed ventricular mass than the opposite groups (p = 0.039). Their ejection fraction was significantly lower than those of the opposite populations (p = 0.000). On the analysis of the correlation between the left ventricular mass and the tension profile, we noted in our series, a strong and significant correlation (r = 0.6342;p = 0.0000) between pulsed pressure and the ventricular geometry change. Conclusion: High ambulatory pulsed pressure remains an independent factor of change in left ventricular geometry in black people.

巨噬细胞移动抑制因子与原发性高血压患者左心室肥厚的关系

目的分析巨噬细胞移动抑制因子(MIF)与原发性高血压患者发生左心室肥厚(LVH)的关系,探讨MIF在原发性高血压患者发生左心室肥厚过程中的作用。方法以2019年1月至2020年9月期间在新疆医科大学第一附属医院心内科接受诊断和治疗的802例原发性高血压患者作为研究对象记录性别、民族、年龄、吸烟史、饮酒史、收缩压、舒张压、体质量指数、心脏超声参数等指标,通过ELISA方法检测血清MIF水平。根据Devereux公式计算左心室质量(LVM)和左心室质量指数(LVMI),并根据LVMI水平(男性>125 g/m^(2)、女性>120 g/m^(2))将患者分为左心室肥厚组(136例)和非肥厚组(666例)。绘制散点图并采用Sperman相关分析MIF与LVM和LVMI的关联。采用多因素logistic回归分析高血压患者发生LVH的影响因素;绘制ROC曲线,评估MIF预测高血压患者发生LVH的效能。结果肥厚组的MIF水平高于非肥厚组,差异具有统计学意义[124.77(79.05,141.58)ng/ml比69.07(51.76,88.08)ng/ml,P<0.05]。此外,肥厚组的男性比例、冠心病病史比例、年龄、高血压病程、收缩压水平均高于非肥厚组(P<0.05)。Sperman相关性分析结果显示,MIF与LVM、LVMI呈正相关(r分别为0.270、0.320)。多因素logistic回归分析结果表明,MIF(OR=1.029,95%CI 1.023~1.036,P<0.001)、收缩压(OR=1.013,95%CI 1.003~1.024,P=0.013)、男性(OR=1.997,95%CI 1.169~3.472,P=0.012)、饮酒(OR=0.356,95%CI 0.173~0.704,P=0.004)是高血压患者发生LVH的影响因素。ROC曲线结果显示,MIF预测高血压患者发生LVH的曲线下面积(AUC)为0.777(95%CI 0.725~0.829,P<0.001)。结论MIF与原发性高血压患者左心室肥厚存在关联,提示MIF可能参与高血压影响心脏功能的过程。

甘油三酯-葡萄糖乘积指数与女性非糖尿病高血压左心室肥厚的相关性探讨

目的:探讨女性非糖尿病高血压患者甘油三酯-葡萄糖乘积(TyG)指数与左心室肥厚(LVH)的相关性。方法:回顾分析133名女性非糖尿病高血压患者,采用Pearson相关性分析与左室质量指数(LVMI)相关的因素,通过二元logistic回归分析获得LVH的影响因素,并通过ROC曲线分析TyG指数预测LVH的最佳截断值以及灵敏度和特异度。结果:在女性非糖尿病高血压患者中,与TyG指数低值组比较,TyG指数高值组其LVMI也较高。Pearson相关性分析发现LVMI与TyG指数、收缩压及夜间舒张压呈正相关(P<0.05)。二元Logistic回归分析显示,TyG指数和夜间收缩压是LVH的预测因素(OR=3.486,95%CI:1.417~8.577;OR=1.048,95%CI:1.019~1.077)。TyG指数与夜间收缩压联合预测LVH的AUC为0.75(95%CI:0.659~0.847),灵敏度为64.7%,特异度为76.8%。结论:在女性非糖尿病高血压患者中,TyG指数和夜间收缩压与左室质量指数呈正相关,可以作为左心室肥厚的预测因子。

急性心肌梗死患者左心室重构与冠状动脉微循环及预后的相关性

目的在急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)且行直接经皮冠状动脉介入(primary percutaneous coronary intervention,pPCI)治疗患者中研究以左心室质量指数(left ventricular mass index,LVMI)为代表的左心室重构与以冠状动脉(冠脉)造影微循环阻力指数(angio-IMR,AMR)为代表的微循环障碍及预后的关系。方法本研究是回顾性病例对照研究,纳入2018年3月至2020年12月于广东省人民医院、广东省人民医院珠海分院和2021年11月至2022年1月于博罗县人民医院确诊STEMI且行pPCI治疗的患者,在术后及3个月后分别行超声心动图检查,计算患者LVMI变化百分比,根据LVMI变化量是否>20%分为高左心室重构组(n=62)、低左心室重构组(n=99)。通过对比两组的一般情况、冠脉微循环指标及预后情况,评价其之间的相关性及结局变量。结果(1)高左心室重构组比低左心室重构组AMR更高(287±89 vs.247±56,P=0.006),冠脉血流速度(coronary flow velocity,CFV)更慢(14.6±5.8 vs.16.6±5.3,P<0.05),预后更差(33.8%vs.13.1%,P=0.003)。LVMI绝对变化量与AMR呈正相关、线性关系(r=0.169,P=0.032)。无复流仅存在于高左心室重构组[3(4.8%)vs.0,P=0.027]。(2)Logistic回归分析表明AMR是LVMI变化量大于20%的危险因素(OR=1.008,P=0.001)。AMR是左心室重构的独立预测因子。受试者工作特征曲线(receiver operating characteristic curve,ROC)分析AMR切点为268.5。结论STEMI患者行pPCI治疗以LVMI为代表的左心室重构与以AMR为代表的冠脉微循环有明确关系,左心室重构变化越大,AMR越大,预后更差。

老年高血压患者血脂异常与左室射血分数及左室质量指数的相关性

目的:探讨老年高血压患者血脂异常与左室射血分数(LVEF)及左室质量指数(LVMI)的相关性。方法:选取2021年1月—2022年1月于大同市浑源县人民医院心血管内科接受治疗的老年高血压患者98例为研究对象,根据低密度脂蛋白胆固醇(LDL-C)水平分为血脂正常组(48例)、血脂边缘升高组(29例)和高脂血症组(21例)。比较三组LVEF及LVMI水平,分析老年高血压患者LDL-C水平与LVEF、LVMI水平的相关性。结果:血脂边缘升高组与血脂正常组LVEF及LVMI水平比较,差异无统计学意义(P>0.05);高脂血症组LVEF水平低于血脂正常组和血脂边缘升高组,LVMI水平高于血脂正常组和血脂边缘升高组,差异有统计学意义(P<0.05)。老年高血压患者LDL-C水平与LVEF水平呈负相关,与LVMI水平呈正相关,差异有统计学意义(r=-0.421、0.324,P<0.001)。结论:老年高血压患者LDL-C水平与LVEF呈负相关,与LVMI呈正相关,临床在关注患者血压变化的同时,也要对其血脂代谢加以重视,减少心脏重构和心血管并发症的发生,改善患者预后。

老年原发性高血压患者24 h尿钠与24 h尿微量白蛋白、左心室质量指数的相关性研究

目的探讨老年原发性高血压患者24 h尿钠与24 h尿微量白蛋白、左心室质量指数(LVMI)之间的关系。方法选取126例老年原发性高血压患者,根据24 h尿微量白蛋白测定值将患者分为观察组(24 h尿微量白蛋白升高,≥30 mg/24 h,61例)和对照组(24 h尿微量白蛋白正常,<30 mg/24 h,65例)。两组患者均接受血压测定、尿生化检测、血生化检测、左心室质量指数测量。比较两组患者血压、尿生化、血生化、左心室质量指数,并进行相关性分析。结果观察组和对照组患者的心率、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖、血钠、血钾、收缩压(SBP)、舒张压(DBP)、肌酐比较差异无统计学意义(P>0.05)。观察组24 h尿微量白蛋白(46.6±4.5)mg/24 h、24 h尿钠(333.4±5.1)mmol/24 h、左心室质量指数(142.5±2.1)g/m2明显高于对照组的(18.1±3.2)mg/24 h、(176.3±3.6)mmol/24 h、(96.5±4.2)g/m2(P<0.05)。对照组内,24 h尿钠与SBP、左心室质量指数、年龄呈正相关(r=0.236、0.178、0.104,P<0.05),与心率、总胆固醇、LDL-C、HDL-C、血钠、血钾、肌酐、空腹血糖、DBP无明显相关性(P>0.05)。观察组内,24 h尿钠与24 h尿微量白蛋白、肌酐、SBP、左心室质量指数、DBP、年龄呈正相关(r=0.106、0.038、0.148、0.112、0.134、0.201,P<0.05),与心率、总胆固醇、LDL-C、HDL-C、血钠、血钾、空腹血糖无明显相关性(P>0.05)。结论老年原发性高血压患者24 h尿钠与24 h尿微量白蛋白、左心室质量指数呈正相关,24 h尿钠能早期反映左心室质量指数变化。

肥厚型梗阻性心肌病行室间隔心肌切除术后转归的回顾性研究

目的阐明肥厚型梗阻性心肌病(HCM)患者术后左心室质量指数(LVMI)的变化与与室间隔心肌切除术的相关性,进一步确定LVMI预测室间隔心肌切除术后转归的价值。方法回顾性纳入2012年9月至2019年12月中国医学科学院阜外医院完成术前及术后左右1年行心脏核磁检查的HCM患者89例,研究室间隔心肌切除术术前和切除术后的左心室质量(LVM)差与手术切除心肌重量的线性相关性,并进行中远期随访,应用Cox比例风险模型构建术后复合不良心血管事件发生的预测模型,并应用Kaplan-Meier生存分析比较不同LVMI组间的室间隔心肌切除术后中远期转归结果。结果术后LVM较术前显著性下降[(187.9±115.3)g比(153.6.9±99.3)g,P<0.001]。手术前后LVM差值为26.7(3.7,61.5)g,术中切除心肌重量平均为(11.0±5.1)g,两者比较具有统计学差异(P<0.001)。设定术中切除心肌重量为自变量,手术前后LVM差值为因变量,二元线性回归分析统计结果表明,手术前后LVM差值与术中切除心肌重量呈线性相关性(P=0.0112,R=0.268,R2=0.072)。9例(10.1%)患者在平均(43.4.6±20.5)个月的随访期间发生不良复合事件。在Cox比例风险回归模型中,室间隔心肌切除术后最显著的预测因子是CMR测量的LVMI(风险比1.025,95%CI 1.009~1.040,P=0.002)。在接受者操作特征曲线(ROC)分析中,LVMI≥95.1 g/m2可准确预测不良复合事件发生(敏感度77.8%;特异度77.5%;曲线下面积AUC=0.748,P=0.0109)。Kaplan-Meier生存曲线图提示,HCM患者LVMI增高组室间隔心肌切除术后中远期不良复合事件发生率高(P<0.001)。结论心肌切除术后左心室心肌质量消退明显大于术中切除心肌重量,室间隔心肌切除术利于梗阻性HCM患者的左心室逆向重构。术前较高的LVMI是HCM患者心肌切除术后中远期不良事件的独立预测因子。

沙库巴曲缬沙坦对初始血液透析患者残余肾功能及左心室质量指数的影响

目的 探讨沙库巴曲缬沙坦对初始血液透析患者残余肾功能及左心室质量指数的影响。方法 选取2022年5月—2023年11月在茂名市中医院进行初始血液透析的60例患者为研究对象,按照患者是否使用沙库巴曲缬沙坦分为对照组及观察组,各30例。对照组接受基础治疗,观察组则在基础治疗的基础上加用沙库巴曲缬沙坦。对比两组治疗效果。结果 治疗后,观察组白蛋白、血红蛋白、前白蛋白水平高于对照组,生化指标、肾功能指标水平低于对照组,心功能指标优于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率(10.00%)低于对照组(23.33%),但差异无统计学意义(χ^(2)=1.920,P>0.05)。结论 沙库巴曲缬沙坦可有效改善初始血液透析患者的实验室指标,提高患者残余肾功能及左心室质量指数。

高血压患者血压昼夜节律、B型脑钠肽与左心室肥厚的关系

目的探讨原发性高血压患者血压昼夜节律、B型脑钠肽(BNP)与左心室肥厚(LVH)的关系。方法纳入349例原发性高血压患者(74例有LVH,275例无LVH)进行超声心动图检测及24 h动态血压监测,计算左心室重量指数(LVMI)、夜间血压下降率、24 h动脉脉压(24 h PP)及动态脉压指数(PPI)。根据昼夜血压变异性将研究对象分为超杓型组(n=7)、杓型组(n=77)、非杓型组(n=173)及反杓型组(n=92)。采集患者一般资料及空腹血样,测定血糖、血脂、血尿素氮、血肌酐、胱抑素C、血尿酸及BNP水平。结果 LVH高血压的3级高血压所占比例(85.1%比46.9%;χ~2=34.428,P<0.001)、24 h平均收缩压(134 mm Hg比129 mm Hg;t=3.175,P=0.002)(1 mm Hg=0.133 k Pa)、白天平均收缩压(134 mm Hg比130 mm Hg;t=2.197,P=0.029)、夜间平均收缩压(132 mm Hg比121 mm Hg;t=4.763,P<0.001)、24 h PP(57 mm Hg比52 mm Hg;t=4.120,P<0.001)及PPI(0.43比0.41;t=3.335,P=0.001)均显著高于非LVH高血压患者,而夜间血压下降率[(1.30±8.02)%比(5.68±7.25)%;t=-4.510,P<0.001]显著低于对照组。LVH高血压患者BNP(87.8 pg/ml比28.8 pg/ml;t=2.170,P=0.034)和LVMI(135.1 g/m^2比88.7 g/m^2;t=15.285,P<0.001)均显著高于非LVH患者。超杓型组、杓型组、非杓型组及反杓型组高血压患者的BNP水平差异无统计学意义(P=0.137),而LVMI差异有统计学意义(P=0.001),其中反杓型组患者的LVMI显著高于杓型组(100.3 g/m^2比86.3 g/m^2;t=4.335,P<0.001)和非杓型组(100.3 g/m^2比93.7 g/m^2;t=1.987,P=0.048),非杓型组患者的LVMI显著高于杓型组(93.7 g/m^2比86.3 g/m^2;t=2.693,P=0.008)。多因素线性相关及Logistic回归分析显示,BNP和高血压分级水平与LVMI相关。结论高血压LVH与血压昼夜节律减弱或消失、血压分级水平密切相关,并伴随血浆BNP升高。

高龄高血压患者心脏结构和功能的变化

目的评价增龄和高血压对高龄高血压患者心脏结构和功能的影响。方法收集150例老年住院患者,按年龄(≥80岁为高龄,60～80岁为老年)和高血压患病情况分为高龄高血压组(n=84)、高龄非高血压组(n=18)和老年高血压组(n=48)。记录患者的基本情况,检测血生化指标,并进行24 h动态血压监测。行心脏超声检查,检测和计算心脏的结构和功能指标;分析高血压患者病程与心脏结构和功能的相关性。结果高龄高血压组患者的平均年龄、体质量指数、总胆固醇、高密度脂蛋白、低密度脂蛋白与老年高血压组比较,差异均有统计学意义(P<0.05或P<0.01)。高龄高血压组患者的24 h收缩压和舒张压均显著高于高龄非高血压组(P<0.01),两组患者的左心室质量、左心室质量指数和左心室后壁厚度比较差异也均有统计学意义(P<0.01);但高龄高血压组的所有心脏结构指标与老年高血压组比较,差异均无统计学意义(P>0.05)。高龄高血压组患者的心脏功能指标与高龄非高血压组和老年高血压组比较,差异均有统计学意义(P<0.05)。相关分析显示,高血压病程与心脏结构指标均呈正相关(P<0.05或P<0.01),但与心脏功能指标均呈负相关(P<0.05)。结论在高龄患者中,高血压导致更显著的左心室壁肥厚、心脏质量增加以及心脏收缩功能下降。随着高血压病程的延长,左心室肥厚、左心房和左心室扩大加剧,左心室收缩功能进一步下降,老年患者应在一定范围内平稳降压。

不同降压方案对老年高血压患者血压控制及左心室肥厚的影响

目的探讨不同降压方案对老年高血压患者血压控制及左心室肥厚的影响,以期指导临床工作。方法选取2012年12月至2014年12月于我院内科住院治疗的162例高血压患者,按随机数表法分为观察组和对照组各81例,观察组患者接受氨氯地平联合氢氯噻嗪治疗,对照组则采用氨氯地平联合厄贝沙坦治疗,连续治疗2个月后,观察两组患者的血压、左室质量指数(LVMI)等指标,并进行对比分析。结果本组患者失访8例,治疗后,观察组患者的收缩压为(123±6)mm Hg,对照组为(129±8)mm Hg,均较同组治疗前明显下降[(157±12)mm Hg、(156±9)mm Hg]且观察组低于对照组,差异均有统计学意义(P<0.05);治疗后,两组患者的LVMI均较治疗前有不同程度减轻,观察组的LVMI为(124±18)g/m2,明显低于对照组的(132±16)g/m2,差异具有统计学意义(P<0.05)。结论氨氯地平联合厄贝沙坦方案和氨氯地平联合氢氯噻嗪方案均能降低患者血压,降低左室质量指数,其中以氨氯地平联合氢氯噻嗪的治疗效果更佳,值得临床推广应用。

原发性醛固酮增多症患者与左心室肥厚

目的探讨原发性醛固酮增多症(原醛)及其主要亚型:腺瘤型和增生型的左室肥厚情况。方法入选确诊原醛患者250例。其中142例行分侧肾上腺静脉取血,分为原醛腺瘤组68例,原醛增生组74例,选取同期年龄、性别、24小时平均血压相匹配的原发性高血压(EH)患者246例作为对照,所有入选者记录一般临床资料和生化指标,并行超声心动图检查。结果1)左室舒张末期内径原醛组[(49.6±4.3)mm]高于EH组[(48.3±4.2) mm,P<0.05],原醛组左室后壁厚度[原醛组(10.5±2.2)mm vs EH组(9.9±1.1)mm]、左室质量(LVM)[原醛组(232.2±75.1)g vs EH组(207.5±46.6)g]、左室质量指数(LVMI)[原醛组(131.9±37.4)g/m^2 vs EH组(118.3±23.7)g/m^2]显著高于EH组(P均<0.01)。2)在原醛组中LVMI与收缩压及立位血浆醛固酮独立相关。3)1级高血压中原醛组的LVMI高于EH组,但差异无统计学意义(P>0.05);2级、3级高血压中,原醛组的LVMI高于EH组(P<0.05或P<0.01)。4)左室后壁厚度[原醛组(10.8±3.0)g vs EH组(10.3±1.3)g,P<0.05];、LVM [原醛组(249.5±81.7)g vs EH组(219.4±67.7)g,P<0.01]、LVMI[原醛组(139.9±41.0)g/m^2 vs EH组(125.1±32.9),P<0.01]原醛腺瘤组显著高于原醛增生组。5)左室肥厚在EH组、原醛腺瘤组和增生组的构成比分别为42.7%,63.2%和43.2%,3组之间差异有统计学意义(P=0.009)。结论原醛患者左室肥厚的发病率高于EH患者,其中以原醛腺瘤组更为严重。

慢性心功能衰竭患者血浆尾加压素Ⅱ、内皮素和肾上腺髓质素的变化

目的研究尾加压素Ⅱ、内皮素和肾上腺髓质素在慢性心功能衰竭患者血浆中含量的变化并探讨其临床意义。方法采用放射免疫法测定40例正常人、42例心功能衰竭患者治疗前后的血浆尾加压素Ⅱ、内皮素和肾上腺髓质素的含量,同时采用彩色多普勒超声心动图测定左心室射血分数和左心室重量指数。结果心功能衰竭患者血浆尾加压素Ⅱ水平明显低于正常对照组(1.53±0.74pmol/L比4.78±1.57pmol/L,P<0.01),治疗后与治疗前相比尾加压素Ⅱ水平明显升高(3.63±1.09pmol/L比1.53±0.74pmol/L,P<0.01)。血浆尾加压素Ⅱ水平与心功能级别负相关(r=-0.77,P<0.01),与左心室射血分数正相关(r=0.80,P<0.01),与左心室重量指数负相关(r=-0.39,P=0.01)。心功能衰竭患者血浆内皮素水平明显高于正常对照组(51.83±11.38ng/L比43.69±4.76ng/L,P<0.05),治疗后轻度升高,较治疗前差异无显著性(P>0.05)。心功能衰竭患者血浆肾上腺髓质素水平明显高于正常对照组(26.14±9.46ng/L比19.10±4.74ng/L,P<0.05),治疗后降低,较治疗前没有统计学差异(P>0.05)。结论多种舒、缩血管活性肽共同参与心功能衰竭的病理生理过程。尾加压素Ⅱ的含量可能作为评价心室重构及心功能衰竭严重程度的指标,它有利于心功能衰竭的诊断,并可能成为心力衰竭治疗的一个新的靶点。

实时三维超声心动图检测左室质量指数评价主动脉瓣置换术后左心室重构的改善情况

目的探索实时三维超声心动图(RT-3DE)计算左室质量指数(LVMI)评估主动脉瓣置换(AVR)前后主动脉瓣病变患者左室重构(LVH)的改善情况。方法选择行AVR 的主动脉瓣疾病患者并定义为病例组(n=68),其中主动脉瓣狭窄(AS)33例,主动脉瓣关闭不全(AI)35例。同期选择健康体检人群作为对照组(n=70)。分别于AVR 前,治疗后1 周、1 个月和6 个月进行超声心动图检查并计算2D-LVMI 和3D-LVMI。所有检查均由2 名超声医师采用单盲独立测量。采用重复测量方差分析比较AS和AI患者2D-LVMI和3D-LVMI的变化差异。采用Bland-Altman 分析和组内相关系数(ICC)对2D-LVMI和3D-LVMI进行重复性检验。结果AS与AI患者的3D-LVMI和2D-LVMI在整个AVR治疗周期中均呈下降趋势,在不同时间段的变化差异有统计学意义(P<0.001)。组间比较发现,AS患者2D-LVMI大于3D-LVMI,差异有统计学意义(P=0.043)。AI与AS患者在AVR术后1周时3D-LVMI低于2D-LVMI,差异有统计学意义(P<0.05)。3D-LVMI在观察者之间ICC结果为0.966;2D-LVMI的ICC结果为0.757,低于3D-LVMI的一致性。结论RT-3DE能够通过LVMI精确评估主动脉瓣病变患者AVR前后LVH的改善情况。

氢氯噻嗪与螺内酯或卡托普利长期合用对原发性高血压患者左室质量参数的影响

目的探讨氢氯噻嗪(HCTZ)与螺内酯或卡托普利长期联用对高血压病患者左室质量参数的影响。方法采用多中心随机双盲研究设计。选择9所开滦矿区医院,筛选出轻、中度高血压病患者。人选患者经安慰剂洗脱2周后随机分为螺内酯组(HCTZ 12.5 mg,1次/d+螺内酯20 mg,1次/d,n=112)和卡托普利组(HCTZ 12.5mg,1次/d+卡托普利25 mg,2次/d,n=109)。共服药36月。治疗期间每月随访1次,监测血压。洗脱期末和治疗12、24、36月末行超声心动图检查并计算左室质量指数(LVMI 或 LVMIh),采静脉血进行生化检查。结果 1)治疗12个月末,两组患者的 LVMI 均较治疗前显著下降(螺内酯组-8.9%,P<0.05;卡托普利组-12.6%,P<0.01);随治疗时间延长,两组患者的 LVMI 进一步下降(36月末与12月末比较,螺内酯组:-8.9%vs-17.5%,P<0.05;卡托普利组:-12.6%vs-19.2%,P>0.05),下降幅度组间比较无统计学意义(P>0.05);2)治疗12、24、36月末两组患者血压均显著下降(P<0.01),下降幅度组间比较,差异无统计学意义(P>0.05)。结论 HCTZ与螺内酯或卡托普利联用均能有效降低血压和 LVMI 或 LVMIh,且随治疗时间延长疗效更为显著。

阻塞性睡眠呼吸暂停综合征对血压、血管内皮功能、肾功能及左室质量的影响研究

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)对动态血压、血管内皮功能、肾功能及左室质量的影响。方法选择我院收治的OSAS患者82例,根据是否合并高血压分为OSAS不合并高血压组(OSAS组)40例,OSAS合并高血压组(OSAS+EH组)42例。选择同期我院高血压患者(EH组)38例及健康体检正常者(NS组)30例。进行动态血压、超声心动图、血一氧化氮(NO)、内皮素(ET-1)、β2微球蛋白(β2-MG)及尿β2-MG测定。结果 (1)3组患者白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)、24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)比较,差异均有统计学意义(P<0.05);3组患者夜间SBP、DBP的下降率比较,差异均有统计学意义(P<0.05)。(2)4组血浆ET-1、血清NO水平比较,差异均有统计学意义(P<0.05),其中OSAS+EH组分别与EH、OSAS组比较,差异均有统计学意义(P<0.01)。(3)4组尿β2-MG水平比较,差异有统计学意义(P<0.05),其中OSAS+EH组分别与EH、OSAS组比较,差异均有统计学意义(P<0.01)。(4)4组左室质量指数(LVMI)比较,差异有统计学意义(P<0.05),其中OSAS+EH组分别与EH、OSAS组比较,差异均有统计学意义(P<0.01)。结论 OSAS患者血压昼夜节律消失,且伴有血管内皮功能紊乱,如合并高血压者则可进一步加重对肾脏、心脏等靶器官的损害。

复方芪麻胶囊对气虚痰浊型高血压患者左心室质量指数的影响

【目的】探讨复方芪麻胶囊对气虚痰浊型高血压左室肥厚患者左心室质量指数(LVM I)的影响。【方法】将100例气虚痰浊型高血压左室肥厚患者随机分为治疗组和对照组各50例。治疗组给予复方芪麻胶囊(主要由黄芪、茯苓、白术、杜仲、天麻、陈皮、法半夏、川芎等药物组成)治疗,对照组给予卡托普利治疗,2组均以6个月为1个疗程。观察2组治疗前后临床症状积分的变化;通过心脏彩超检测治疗前后舒张期室间隔厚度(IVST)、左室舒张末期内径(LVDd)和左室后壁厚度(LVPWT),取其均值,测患者身高、体质量,计算体表面积(BSA),根据公式计算左室心肌质量(LVM)及其指数(LVM I)。【结果】(1)治疗后2组患者的症状积分均有明显降低,与治疗前比较差异均有显著性意义(P<0.05);治疗后组间比较差异均有显著性意义(P<0.05),表明治疗组在改善症状积分方面优于对照组。(2)治疗后2组患者的LVM I均有明显降低,与治疗前比较差异均有显著性意义(P<0.05);治疗后组间比较差异无显著性意义(P>0.05),表明2组在改善LVM I方面作用相仿。【结论】复方芪麻胶囊能降低气虚痰浊型高血压患者的LVM I,具有一定预防心室重构的作用。