高血压患者心肌缺血与室间隔及左室壁厚度的相关性研究

目的　探讨高血压患者的心肌缺血与室间隔（IVS）及左心室后壁（LVPW）厚度之间的相关性。方法 收集2005年5月至2008年9月在我院经查冠脉CTA排除冠心病的高血压患者共76例，根据Holter上有无发作性ST段压低为标准将资料分为有无心肌缺血2组，分析其与IVS及LVPW厚度之间的相关性，并比较2组间IVS及LVPW厚度的大小；然后以单因素及多因素分析筛选心肌缺血的影响因素；最后建立ROC曲线评估IVS及LVPW厚度预测心肌有无缺血的价值。结果　高血压患者心肌有无缺血与IVS及LVPW的厚度均呈正相关（r=0.362, P=0.001; r=0.298, P=0.009），伴有心肌缺血组IVS及LVPW厚度与无心肌缺血组相比有统计学意义（t=3.313, P=0.002; t=2.369, P=0.020）；伴有IVS增厚的高血压患者其心肌缺血的发生率明显高于无IVS增厚的患者（χ2=9.694，P=0.002）；多因素分析中只有IVS厚度被筛选出来（OR=1.710, P=0.002）；以IVS厚度预测心肌有无缺血的ROC曲线下面积AUC为0.715±0.067，P=0.002，最佳分界值为10.5mm，以IVS≥10.5mm来预测心肌缺血，敏感性为59.3%，特异性为89.8%。LVPW厚度预测心肌缺血的AUC为0.675±0.065，P=0.012。结论 高血压患者有无心肌缺血与IVS及LVPW厚度均呈正相关，但与IVS厚度相关性更密切；以IVS厚度预测高血压患者有无心肌缺血的特异性较高，但敏感性较差。

Correlation between myocardial ischemia and the thickness of interventricular septum and left ventricular posterior wall in hypertensive patients

Objective To analyze the correlation between myocardial ischemia and the thickness of interventricular septum (IVS) and left ventricular posterior wall (LVPW) in hypertensive patients. Methods The clinical data of 76 hypertensive patients,excluding the complication of coronary artery disease via cardiac computed tomographic angiography (CTA),were collected. Cases were divided into two groups with or without myocardial ischemia according to Holter examination. Correlation analysis between myocardial ischemia and the thickness of IVS and LVPW was preformed,and the thickness of IVS and LVPW were compared. Univariate and multivariate analysis were used to screen the risk factors of myocardial ischemia. The receiver operating characteristic (ROC) curves were used to evaluate diagnostic value of the thickness of IVS and LVPW of myocardial ischemia in hypertensive patients. Results The presence of myocardial ischemia in hypertensive patients positively correlated with the thickness of IVS and LVPW ( r=0.362,P =0.001 and r=0.298,P =0.009). Significant differences in the thickness of IVS and LVPW were found between the groups with and without myocardial ischemia in hypertensive patients. The incidence rate of myocardial ischemia was higher in the hypertensive patients with increased thickness of IVS than that in the patients without increased thickness of IVS. The increased thickness of IVS was screened out by multivariate analysis as the only risk factor of myocardial ischemia in hypertensive patients. The area under cure (AUC) of the ROC curve of the thickness of IVS in predicting myocardial ischemia in hypertensive patients was 0.715±0.067, P =0.002,with the optimal cut-off value 10.5 mm. Thickness of IVS ≥10.5 mm could predict myocardial ischemia in hypertensive patients with a sensitivity of 59.3% and spectificity of 89.8%. The AUC of the ROC curve of thickness of LVPW was 0.675±0.065, P =0.012. Conclusion The prensence of myocardial ischemia in hypertensive patients has positive correlation with the thickness of IVS and LVPW,but it shows closer correlation with the thickness of IVS. Thickness of IVS predicts the presence of myocardial ischemia in hypertensive patients with a superior spectificity and fairly sensitivity.