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[摘要] 目的:观察原发性高血压病患者昼夜节律与左心室肥厚的关系。方法:134例原发性高血压病患者采用动态血压监测仪测定动态血压,采用心超评价左心室肥厚情况,分析血压节律和左心室肥厚的关系。结果:134例高血压患者中,节律异常的非杓型血压患者13例(9.7%)。血压节律异常与性别、年龄、BMI和高血压严重程度等方面均无关(P>0.05),而和心室重量指数有关(t=7.913,P=0.000)。非杓型血压组左心室肥厚发生率为69.2%,高于杓型血压组左心室肥厚发生率为18.2%(χ2=17.203,P=0.000),OR值为10.125,95%CI为2.488～48.010。Logistic回归分析显示血压节律异常和高血压严重程度、血压控制情况及脉压大小同是引起高血压并发左心室肥厚的独立危险因素。结论:原发性高血压病患者的昼夜节律异常容易并发左心室肥厚。因此在高血压的治疗中除了控制血压的绝对值外,还应注意调节血压的正常生理节律。
[关键词] 原发性高血压病;节律;左心室肥厚
[中图分类号] R544.1 [文献标识码]A [文章编号]1674-4721(2010)04(c)-017-03
The relationship between abnormal circadian rhythm of blood pressure and left ventricular hypertrophy in patients with hypertension
SHU Xiaochun,JIANG Shijun,XU Shaoyong
(Xupu People"s Hospital, Huaihua City, Hunan Province, Xupu 419300, China)
[Abstract] Objective: To observe the relationship between abnormal circadian rhythm of blood pressure and left ventricular hypertrophy in patients with hypertension. Methods: Used ambulatory blood pressure to monitor the blood pressure in 134 patients with primary hypertension,left ventricular hypertrophy was measured by cardiac ultra-evaluation. Results: In 134 patients with hypertension,13 patients with non-dipper blood pressure(9.7%). Blood pressure rhythm abnormalities had no relationship with gender,age,BMI(P>0.05), but related with ventricular weight index (t=7.913,P=0.000). The incidence of left ventricular hypertrophy in non-dipper blood pressure group was 69.2%,higher than that of 18.2% in the dipper blood pressure group (χ2=17.203,P=0.000), The OR value 10.125, 95% CI of 2.488-48.010. Logistic regression analysis showed that blood pressure rhythm abnormalities, hypertension severity, blood pressure controls and pulse pressure were the independent risk factor for left ventricular hypertrophy in patients with essential hypertension. Conclusion: The circadian rhythm abnormalities of patients with hypertension are easy to complicate with left ventricular hypertrophy. Therefore, in the treatment of hypertension, we must also regulate the normal physiological of blood pressure rhythm.
[Key words] Essential hypertension; Rhythm; Left ventricular hypertrophy
左心室肥厚(left ventricular hypertrophy, LVH)是高血压状态下机体为减少室壁张力,维持心脏功能的一种代偿,是高血压的主要并发症之一。LVH作为心血管疾病的独立危险因子已成为共识,存在LVH的患者预后较差[1]。高血压的异常病变除了表现为压力值的增高,还表现为血压波动节律性的改变。正常血压的昼夜节律为双峰一谷,形状如长杓状,称为杓型血压;但6%～10%的高血压患者血压节律消失,夜间平均血压下降幅度不足10%,为非杓型血压[2]。本研究观察原发性高血压病患者昼夜血压节律与LVH的关系,为高血压患者防止LVH提供依据。
1 资料与方法
1.1 一般资料
2009年1～12月入本院治疗的原发性高血压病患者为研究对象。纳入标准:①符合2005年中国高血压防治指南(修订版)的高血压诊断标准;②初治或停药2周以上的患者;③对本研究知情同意。排除标准:①继发性高血压;②风湿性心脏病;③瓣膜性心脏病;④心肌病;⑤肺源性心脏病;⑥肝肾功能不全者。共入选患者134例,其中,男72例,女62例;年龄45～78岁,平均(61.3±8.4)岁;体重指数(body mass index, BMI)(25.9±4.8) kg/m2;血压(158.1±14.8)/(95.6±7.1) mmHg,其中Ⅰ级高血压42例、Ⅱ级高血压71例、Ⅲ级高血压21例;病程1～29年,平均(14.1±6.2)年。
1.2 动态血压测量(ABPM)
采用无创性携带式Medilog DX型动态血压监测仪(英国Oxford公司),经数据统计分析得出24 h、白昼及夜间平均血压、心率。血压波动的昼夜节律采用夜间血压下降率表示,即(日间平均值-夜间平均值)/日间平均值,以小于10%为血压昼夜节律异常。
1.3 左心室肥厚测量
采用美国GE通用电器公司Vivid 7型彩色多普勒超声心动图仪,探头频率10 MHz,测量左心室舒张末内径、室间隔厚度、左心室后壁厚度。根据Penn校正公式计算左心室重量(left ventricular mass, LVM),根据Stevenson校正公式计算体表面积,得左心室重量指数(LVMI)。根据国内左心室肥厚标准:男性>125 g/m2,女性>120 g/m2判断左心室肥厚情况[3]。
1.4 统计学方法
连续变量以(x±s)表示,组间比较采用t检验;计数资料组间比较采用χ2检验。采用非条件Logistic回归分析确定高血压并发LVH的危险因素。P
