H 型高血压与左心室重构的关系探讨

【摘要】目的：探讨HHcy（高同型半胱氨酸血症）与高血压对左心室重构的发生及严重程度是否存在协同作用。方法：选取就诊于天津市胸科医院心内科患者275例，根据血压及Hcy水平将患者分为四组，H型高血压组96例； 非H型高血压组44例；高Hcy非高血压组70例；对照组65例。分析比较各组患者左室壁相对厚度、左心室质量指数（g/m2)以及发生左心室重构的患者比例。结果： H型高血压组与非H型高血压组、高Hcy非高血压组、对照组相比，H型高血压患者左室壁相对厚度、左室质量指数以及发生左心室重构患者的比例均较高，分别为（0.47±0.11）Vs（0.35±0.08）Vs（0.34±0.07）Vs（0.30±0.05）,（167.45±63.62）Vs（135.06±44.19）Vs（130.77±33.21）Vs（100.13±14.41）， (40.6%)Vs（20.5%）Vs（28.3%）Vs（3.1%），均p＜0.05]。Logistic回归分析提示，HHcy（OR=47.825 ，P ＜0.05 ）、患有高血压、及二者共存时是影响左心室重构的危险因素。结论：HHcy和高血压是导致左室重构的危险因素，HHcy与高血压共存时对左心室重构的发生及严重程度存在协同作用，强调了防治H型高血压时需要在降压的基础上同时降低血浆同型半胱氨酸水平。

Research of the risk that H-type hypertension leading to left ventricular remodeling

Abstrac Objective: To study If there is a synergistic effect on leading to left ventricular remodelingwhen the patient both suffer from homocystinemia and hypertension.Methord:Choose 275 TianjinChest Hospital Cardiology in-patients and divide them into 4 groups based on their plasma homocysteine level and whether suffer from hypertension。Then analyse and compare left ventricular relative thickness、Left ventricular mass index（LVMI）、the proportion of left ventricular remodeling in the 4 groups. Results:The H- hypertension Group has a higher level in left ventricular relative thickness、Left ventricular mass index（LVMI）、the proportion of left ventricular remodeling copared to the other 3 groups[（0.45±0.11）Vs（0.43±0.09）Vs（0.42±0.15）Vs（0.33±0.12），（130.12±55.73）Vs（110.17±58.20）Vs（110.35±44.86）Vs（93±20.33），（40.2%）Vs（22.7%）Vs（24.3%）Vs（3.1%），p＜0.05]. Conclusion: Homocysteine and systolic pressure are both independent risk factors for left ventricular remodeling and they have a synergistic effect on leading to left ventricular remodeling.Which stress out that we should control blood pressure as well as reduce plasma homocysteine level