高血压左室舒张早期血流传播特点及与内分泌因子的关系

目的应用超声技术探讨高血压病患者左室舒张早期血流传播特点及其与内分泌因子的关系.方法 61例高血压病患者根据左室质量指数(LVMI)分为左室心肌肥厚组(LVH,30例)和无心肌肥厚组(NLVH组,31例);20例健康者为对照组.二维及M-型超声心动图测量舒张末期室间隔厚度、左室后壁厚度、左室内径以及左室射血分数,计算LVMI.脉冲波多普勒超声测量二尖瓣血流频谱,测量舒张早期最大血流速度(E0)、舒张晚期最大血流速度(A)及其比值(E0/A),舒张早期二尖瓣瓣下3 cm处的最大血流速度(E3);舒张早期二尖瓣瓣尖心电图R波顶峰至E波峰值的时间(R-E0)、瓣下3 cm的心电图R波顶峰至E波峰值的时间(R-E3)以及两时间间期的比值(R-E3/R-E0).放射免疫分析血浆心钠素(ANP)、脑钠素(BNP)、内皮素(ET)、降钙素基因相关肽(CGRP)及血清胰岛素样类生长因子-1(IGF-1)的浓度.结果对照组、NLVH组、LVH组E0/A比值依次减小(P＜0.001);对照组、NLVH 组、LVH组E3依次降低(P＜0.05),R-E3/R-E0比值延长(P＜0.01).E0/A与ET、ANP、BNP及IGF-1呈显著负相关(r分别为-0.82,-0.65,-0.60,-0.65; P＜0.01),与CGRP中度正相关(r＝0.64,P＜0.01);E3与ET、ANP呈轻度负相关(r＝-0.36,-0.31;P＜0.01),与CGRP轻度正相关(r＝0.22,P＜0.01);R-E3/R-E0与ET、ANP、BNP及IGF-1呈显著正相关(r分别为0.61,0.62,0.79,0.73;P＜0.01),与CGRP中度负相关(r＝-0.70,P＜0.01).结论高血压病患者左室舒张早期血流传播延缓,速度减低,左室舒张功能异常与内分泌因子有关.

Relationship Between Left Ventricular Diastolic Blood Flow Propagation and Endocrine Factors in Hypertension

Objective To study the changes of diastolic blood flow propagation of left ventricle by Doppler echocardiography and the serum levels of endocrine factors,and analyse the relationship between these factors and the diastolic function of the left ventricle in patients with hypertension.Methods A total of 61 patients with hypertension were divided into left ventricular hypertrophy (LVH) group and no left ventricular hypertrophy (NLVH) group Twenty healthy subjects were considered as the control group The peak flow velocity E at mitral tip level (E 0) and at 3 cm below the tip toward the apex(E 3) and the interval from ECG peak of R to the peak velocity E(R E 0,R E 3,R E 3/R E 0) were measured by pulsed Doppler The levels of atrial natriuretic peptide(ANP),brain natriuretic peptide(BNP),endothelin(ET),insulin like growth factor 1(IGF 1) and calcitonin gene related peptide (CGRP) were measured by radio immunology analysis.Results The E 0/A and E 3 were decreased sequentialy in the control group,NLVH group,LVH group ( P <0 05),while R E 3/R E 0 was prolonged( P <0 01) There were negative correlations between the E 0/A and ET,ANP,BNP,IGF 1 endocrine factors ( r =-0 82, -0 65, -0 60,-0 65,respectivly, P <0 01)and positive correlation between the E 0/A and CGRP( r =0 22, P <0 01) There were moderate positive correlations between the R E 3/R E 0 and ET,ANP,BNP,IGF 1( r =0 61,0 62,0 79,0 73,respectivly, P <0 01) and negative correlation between the R E 3/R E 0 and CGRP ( r =-0 70, P <0 01).Conclusions The decreased diastolic blood flow propagation of the left ventricle examined by Doppler correlated with changes of the endocrine factors in patients with hypertension