长期吸烟对高血压病患者心脏结构和功能的影响

目的 通过对比吸烟和不吸烟的高血压病患者心脏结构和功能指标的差异，探讨长期吸烟对高血压病心血管重构附加的不利影响。方法 以超声心动图检测89例未服药治疗的轻中度高血压病患者左右心腔及大血管内径、室壁厚度、收缩功能和舒张功能指标，并计算左室肌重量(LVM)、左室肌重量指数(LVMl)、平均室壁厚度(ALVT)、体循环血管阻力(SVR)、左室收缩末期室壁应力(ESS)；其中不吸烟者57例，长年吸烟者32例。检测前2小时内不吸烟以避免吸烟的即刻效应；通过协方差分析校正年龄、性别、体重指数、收缩压、血压水平、吸烟程度、心率以及血色素等的混杂影响后，对比长期吸烟与不吸烟的高血压病患者左房、左右心室结构及功能指标的差异。结果 长期吸烟的高血压病患者，平均室壁厚度、室间隔厚度、左室肌重量及指数、左房内径、右室前壁厚度、主动脉内径、主肺动脉内径以及反映左室后负荷的指标SVR及ESS较不吸烟者显著增大；左室收缩和舒张功能变化较小，而右室舒张功能有所减迟。结论 长期吸烟可能促进或加重轻中度高血压病患者的心血管重构。

The Effects of Long-term Cigarette Smoking on Cardiac Structure and Function in Patients with Mild and Middle Essential Hypertension

Objective To assess the effects of long term cigarette smoking on cardiacvascular remodling in patients with essential hypertension by comparing the differences of cardiac structures and functions between mild or middle hypertensive chronic smokers and non smokers. Method Indices of cardiac structures, including dimensions of left atrium, left and right ventricule, aorta, thickness of ventricular wall and indices of systolic and diastolic function, were measured by echocardiography in 89 untreated patients with mild or middle essential hypertension. Left ventricle muscle mass(LVM), LVMI, average left ventricular thickness(ALVT), systemic vascular resistance(SVR) and end systolic left ventricular wall stress(ESS) were calculated. Differences between hypertensive chronic smokers( n =32) and non smokers( n =57) were compared after adjustment of confound effects of age, gender, body mass index(BMI), the levels of blood pressure, smoking, heart rate and Hb by covariance analysis. Results Compared with hypertensive nonsmokers, in hypertensive smokers, the average thickness of left ventricular wall, thickness of interventricular septum, LVM, LVMI and the dimensions of left atrium, aorta and main pulmonary artery, as well as SVR and ESS increased, the changes of indices of left ventricular systolic and diastolic function were not significant but the right ventricular diastolic function decreased in hypertensive smokers. Conclusions Long term cigarette smoking may accelerate or aggravate the cardiovascular remodeling in mild or moddle hypertensive patients.