BNP及PCⅢ对不同左心室舒张充盈状态原发性高血压患者的影响分析

目的 分析血浆B型O脑钠肽(natriuretic peptide,BNP)及血清前Ⅲ型胶原(procollagen typeⅢ,PCⅢ)对不同左心室舒张充益类型的原发性高血压(高血压)患者的影响.方法 入选高血压患者150例.均无收缩功能障碍,根据左心室舒张充盈类型不同分为正常舒张充盈型组、松驰受损型组、假正常充盈型组、限制性充盈型组,所有患者均行多普勒超声心动图检查,用干式快速免疫荧光法定量测定血浆B型BNP浓度.用放射免疫法测定血清PCⅢ浓度.结果 ①正常舒张充盈型组、松弛受损型组、假正常充盈型组、限制性充盈犁组的B型BNP分别为(47±16)pg/mL、(147±24)pg/mL、(206±51)pg/mL、(357±64)pg/ml;正常舒张充盈型组、松弛受损型组、假正常充盈型组、限制性充盈型组PCⅢ分别为(81/5±31/4)μg/L、(107/8±30/8)μg/L、(125.3±37.3)μg/L、 (157.4±55.4)μg/L,以限制性充盈型组增高最显著,方差分析显示B型BNP与PCⅢ在高血压患者4组间的差异有统计学意义(F=406.6,P<0.05;F=25.4,P<0.05).②血浆B型BNP与血清PCⅢ呈正相关(r=0.580,P<0.05).结论 血浆B型BNP及血清PCⅢ可客观反映无收缩功能障碍的高血压患者左心室舒张功能受损程度.     

老年收缩期高血压左室肥厚与心肌缺血、室性心律失常和心衰的相关性

目的 :探讨老年收缩期高血压左室肥厚与心肌缺血、心律失常、心衰间的相关性。方法 :以动态心电图和超声心动图分别检测 6 8例老年收缩期高血压左室肥厚 (HL VH)患者及 30例老年单纯收缩期高血压 (SHT)患者的心肌供血、心律和心功能。结果 :HL VH组心肌缺血、室性早搏的发生率显著高于 SHT组 ;左室收缩功能障碍组 L VEF,CI明显减低 ;左室舒张功能障碍组二尖瓣舒张早期流速 (E峰 )、E/ A、舒张早期减速度显著减低。结论 :老年收缩期高血压左室肥厚与心肌缺血、室性心律失常、心衰间关系密切 ,是一项独立的心血管病死亡的重要危险因素。     

老年冠心病患者心律失常的动态心电图特点及其临床意义

对192例老年冠心病患者和180例中年冠心病患者的动态心电图对比分析后发现。老年组除白天最慢心率外,其余各项心率均低于中年组(P<0.05)。老年组各种心律失常的总发生率,尤其是复杂心律失常的发生率明显高于中年组(P<0.005)。伴有心肌缺血和左室功能障碍的患者。其室性心律失常的总发生率和Ⅲ级以上室性心律失常的发生率明显高于无心肌缺血和左室功能正常的患者(P<0.005)。     

高血压左室舒张功能对心房电-机械时间的影响

目的采用组织多普勒成像(TDI)研究原发性高血压患者左室舒张功能对心房电机械时间的影响。方法原发性高血压患者90例,根据左室舒张功能将其分为3组:正常充盈组(NF组,32例)、松弛功能受损组(IR组,28例)、假性正常化/限制性充盈组(PN/R组,30例)。采用TDI分别测量左、右房室瓣瓣环处的心房电机械时间(LPA与RPA)。结果与NF组比较,LPA与RPA值在IR组和PN/R组延长;与IR组比较,PN/R组的LPA与RPA值延长[(分别为74.1±11.6vs83.1±13.7、40.3±10.5vs47.7±10.4)ms,P<0.05]。结论原发性高血压患者的心房电机械时间随左室舒张功能受损加重而延长,在假性正常化/限制性充盈阶段明显延长,该参数可以做为其他超声诊断心室舒张指标的一个补充指标。     

高血压左室舒张功能对心房电-机械时间的影响

目的采用组织多普勒成像(TDI)研究原发性高血压患者左室舒张功能对心房电机械时间的影响.方法原发性高血压患者90例,根据左室舒张功能将其分为3组:正常充盈组(NF组,32例)、松弛功能受损组(IR组,28例)、假性正常化/限制性充盈组(PN/R组,30例).采用 TDI分别测量左、右房室瓣瓣环处的心房电机械时间(LP-A与RP-A).结果与 NF组比较,LP-A与RP-A值在IR组和PN/R组延长;与IR组比较,PN/R组的LP-A与RP-A值延长[(分别为 74.1±11.6 vs 83.1±13.7、40.3±10.5 vs 47.7±10.4)ms,P<0.05].结论原发性高血压患者的心房电机械时间随左室舒张功能受损加重而延长,在假性正常化/限制性充盈阶段明显延长,该参数可以做为其他超声诊断心室舒张指标的一个补充指标.     

高血压病患者左室舒张功能不全与U波关系探讨

目的　探讨高血压患者左室舒张功能不全与U波的关系。方法　用超声心动图对104例高血压病患者的舒张早期最大峰值速度（E峰）,舒张晚期最大峰速度（A峰）,左室射血分数（LVEF）,左房内径进行测量。将其分为左室舒张功能正常及左室舒张功能不全组。另有46个年龄相当的正常人作为对照组。对所有病人及对照组行常规心电图检查,分析U波形态。结果　左室舒张功能不全组的U波倒置发生率明显高于左室舒张功能正常组及正常对照组(24%vs15%and13%),前者与后二者相比有显著性差异（P<0.01）。结论　U波倒置可能是高血压病左室舒张功能不全的标志之一。     

肥胖对2型糖尿病患者左室舒张功能的影响

目的:通过超声心动图左室舒张功能各项指标的测定,探讨不同程度的肥胖对2型糖尿病患者左室舒张功能的影响。方法:对90例2型糖尿病患者测定身高、体重,计算体重指数(BMI)。根据体重指数的不同,分为三组:正常体重组、超重组、肥胖组。每组病人均测定左室舒张功能指标即左室舒张早期充盈峰值流速(Peak E)、晚期充盈峰值流速(Peak A)、A/E比值、等容舒张时间(IRT)、左房直径(LAD)、二尖瓣半压时间(MV1/2T)。比较各组心脏左室舒张功能情况。结果:BMI与Peak E呈负相关(r=-0.235,P<0.05);BMI与A/E比值呈正相关(r=0.195,P<0.05);BMI与IRT呈负相关(r=-0.163,P<0.05)。2型糖尿病早期亚临床心脏左室舒张功能异常的发生率分别36%;47%;58%。结论:2型糖尿病早期即存在左室舒张功能异常;肥胖加重心脏左室舒张功能异常。     

高血压频发室性心律失常合并胃溃疡的药物治疗

老年人高血压常伴有种种合并症,今就老年高压合并室性心律失常以及老年高血压合并胃溃疡的药物治疗进行介绍。老年高血压与心律失常老年与心律失常杉浦等报告,60岁以上尸检1000例,其中室上性早搏占34.2％,窦速占15.3％,室性早搏占14.3％,Ⅰ度房室阻滞占14.1％,窦缓占13.6％,房颤占12.2％。对老年心律失常治疗的适应症,治疗方法及药物选择,与一般成年人无明显差异。高血压与心律失常高血压为心律失常的基础疾病。室性早搏与血压值呈正相关,室上性早搏在收缩压高峰时增多。长期高血压可引起左室肥厚。伴有左室肥厚的高血压较不伴有者的室上性和室性心律失常发生率高,这与心肌细胞肥大、心肌内局限性纤维化、心内膜下缺血、冠脉内膜肥厚等许多因素有关。使左室肥厚消退的降压药有钙通道阻滞     

原发性高血压心律失常的预测因素

目的：探讨原发性高血压（EH）心律失常的预测因素,方法：采用超声心动图和动态心电图观察EH患152例,按左室肥厚,左房增大,心肌缺血,年龄,病程分类,并比较各类与心律失常关系。结果：（1）EH左室肥厚组室性心律失常发生率高于左室正常组,尤其是Lown3级以上更为显（P＜0．01）,（2）左房增大组阵发性房速或房颤发生率高于左房正常组（P＜0．05）,（3）心肌缺血组易导致严重室性心律失常;（4）年龄大及病程长易发生室性心律失常,尤其是严重室性心律失常,结论：左室肥厚,左房增大,心肌缺血,左室舒张功能减退是EH心律失常的预测因素。     

老年单纯收缩期高血压左室肥厚心律失常研究

目的研究老年单纯收缩期高血压患者左室肥厚与心律失常关系。方法60岁以上老年单纯收缩期高血压患者63例,平均年龄77.67±5.67岁,其中男性49例,女性14例,排除其他继发性高血压、糖尿病、冠心病等疾病,分别测量身高、体重、血脂、血糖、肝肾功能、心脏彩超、24小时动态心电图监测。计算BMI、左室重量(LVM)、左室重量指数(LVMI),根据结果分为左室肥厚组(LVH)及非左室肥厚组(non-LVH),分析其心律失常情况。63例老年单纯收缩期高血压患者,检出左室肥厚患者20例,占31.75%;非左室肥厚患者43例,占68.25%。结果左室肥厚组与非左室肥厚组在年龄、血脂水平、BMI、房性心律失常的检出率等各项指标上无统计学意义。复杂性室性心律失常(Lown3-6级)的发生率与非左室肥厚组比较有统计学意义(P<0.001)。结论左室肥厚可能是引起老年单纯收缩期高血压患者复杂性室性心律失常的一个重要原因。     

High levels of plasma atrial natriuretic factor and impaired left ventricular diastolic function in hypertensives without left ventricular hypertrophy.

OBJECTIVE: To seek possible correlations between plasma atrial natriuretic factor (ANF) and left ventricular diastolic function (LVDF) in hypertensive patients. DESIGN: Since LVDF abnormalities can be detected in patients with normal left ventricular mass, we studied a group of hypertensive patients without left ventricular hypertrophy. METHODS: Untreated hypertensive patients (n = 23) and normotensive control subjects (n = 19) were studied. LVDF indices were obtained by M-mode and pulsed Doppler echocardiography. Blood samples for plasma ANF were taken in the recumbent position from subjects on normal-sodium intake. RESULTS: Plasma ANF levels were significantly higher in hypertensive patients than in normotensive subjects. All indices for systolic function were normal in both normotensive subjects and hypertensive patients. Left atrial diameter was significantly higher for hypertensive patients than for normotensive subjects. Considering LVDF, all indices for ventricular filling were found to be altered, on average, in hypertensive patients, the only exception being peak early velocity. In addition, significant correlations were found between plasma ANF and the pulsed Doppler parameters of left ventricular filling, peak atrial velocity and the peak early:peak atrial velocity ratio. Overall correlations between plasma ANF and left atrial diameter, and between left atrial diameter and left ventricular mass index were also observed. CONCLUSIONS: The high levels of plasma ANF observed in our hypertensive patients and their correlation with the LVDF indices (which mainly reflect the atrial contribution to ventricular filling) could be the result of an increased atrial stretch due to diastolic ventricular dysfunction. This may exist in hypertensive patients before the development of ventricular hypertrophy.     

BNP及PCⅢ对不同左心室舒张充盈状态原发性高血压患者的影响分析

目的分析血浆B型0脑钠肽（natriuretic peptide,BNP）及血清前Ⅲ型胶原（procollagen typeⅢ,PCⅢ）对不同左心室舒张充盈类型的原发性高血压（高血压）患者的影响。方法入选高血压患者150例,均无收缩功能障碍,根据左心室舒张充盈类型不同分为正常舒张充盈型组、松驰受损型组、假正常充盈型组、限制性充盈型组．所有患者均行多普勒超声心动图检查,用干式快速免疫荧光法定量测定血浆B型BNP浓度,用放射免疫法测定血清PCⅢ浓度。结果①正常舒张充盈型组、松弛受损型组、假正常充盈型组、限制性充盈型组的B型BNP分别为（47±16）pg／mL、（147±24）pg／mL、（206±51）pg／mL、（357±64）pg／ml;正常舒张充盈型组、松弛受损型组、假正常充盈型组、限制性充盈型组PCⅢ分别为（81．5±31．4）μg／L、（107．8±30．8）μg／L、（125．3±37．3）μg／L、（157．4±55．4）μg/L,以限制性充盈型组增高最显著,方差分析显示B型BNP与PCⅢ在高血压患者4组间的差异有统计学意义（F=406．6,P〈0．05;F=25．4,P〈0．05）。②血浆B型BNP与血清PCⅢ呈正相关（r=0．580,P〈0．05）。结论血浆B型BNP及血清PCⅢ可客观反映无收缩功能障碍的高血压患者左心室舒张功能受损程度。     

原发性高血压左心室不同构型民律失常的比较

目的 研究原发性高血压患者左心室重构不同构型间心律失常的差异。方法 179例原发性高血压患者均进行了24h动态心电图，动态血压监测，超声心动图等检查，根据检查结果划分左心室构型，判定心律失常，比较左心室重构组与正常构型组心律失常的发生率；通过多元逐步回归分析，甄选出对心律失常有独立影响的因素。并在校正这些影响因素后，比较左心室不同构型间心律失常严重程度的差异。结果 左心室重构组的房性心律失常，室性心律失常，复杂室性心律失常的发生率均显著高于正常构型组，而影响原发性高血压心律失常的相对独立因素很多，其中部分左心室解剖结构指标，高血压分级，左心房内径，E/A值，夜间舒张压负荷值以及日平均心率等占重要地位；校正上述影响因素后，不同构型两两比较时，部分构型之间心律失常分级级别仍存在差异，且差异为构型本知差异所致。结论 原发性高血压心律失常的影响因素很多（例如高血压分级、左心室重量指数，左心房内径，左心室后壁厚度等），不同构型间心律失常的严重程度存在差异。     

Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women

OBJECTIVES: The objective of this study was to determine whether diastolic dysfunction is associated with increased risk of nonvalvular atrial fibrillation (NVAF) in older adults with no history of atrial arrhythmia. BACKGROUND: Few data exist regarding the relationship between diastolic function and NVAF. METHODS: The clinical and echocardiographic characteristics of patients age > or =65 years who had an echocardiogram performed between 1990 and 1998 were reviewed. Exclusion criteria were history of atrial arrhythmia, stroke, valvular or congenital heart disease, or pacemaker implantation. Patients were followed up in their medical records to the last clinical visit or death for documentation of first AF. RESULTS: Of 840 patients (39% men; mean [+/- SD] age, 75 +/- 7 years), 80 (9.5%) developed NVAF over a mean (+/- SD) follow-up of 4.1 +/- 2.7 years. Abnormal relaxation, pseudonormal, and restrictive left ventricular diastolic filling were associated with hazard ratios of 3.33 (95% confidence interval [CI], 1.5 to 7.4; p = 0.003), 4.84 (95% CI, 2.05 to 11.4; p < 0.001), and 5.26 (95% CI, 2.3 to 12.03; p < 0.001), respectively, when compared with normal diastolic function. After a number of adjustments, diastolic function profile remained incremental to history of congestive heart failure and previous myocardial infarction for prediction of NVAF. Age-adjusted Kaplan-Meier five-year risks of NVAF were 1%, 12%, 14%, and 21% for normal, abnormal relaxation, pseudonormal, and restrictive diastolic filling, respectively. CONCLUSIONS; The presence and severity of diastolic dysfunction are independently predictive of first documented NVAF in the elderly.     

老老年高血压病患者左心室肥厚与心律失常及心率变异性的关系研究

目的：研究老老年高血压患者左心室肥厚(LVH)与心律失常及心率变异性(HRV)的关系。方法：纳入2012年10月至2014年7月于中国中医科学院广安门医院心内科住院的303例老老年高血压病患者,根据是否合并左心室肥厚分为2组,检测24小时动态心电图心率变异性时域分析及超声心动图,观察2组之间相关指标的差异。结果：老老年高血压合并LVH组较不合并LVH组房性、室性心律失常检出率增高,差异具有统计学意义(P<0.05),二组PNN50、RMSSD、SDNN、SDANN差异无统计学意义。结论：老老年高血压合并LVH心律失常的发生率明显增高,而二者心率变异性无明显差异。     

高血压患者伴发快速房性心律失常与左房室重塑

目的探讨伴发快速房性心律失常的高血压患者左房室形态重塑、左室肥厚性重塑与未伴发快速房性心律失常患者之间的异同。方法97例门诊或住院的原发性高血压患者，经24h Holter检查分为高血压合并快速房性心律失常组及单纯高血压组，并行超声心动图检查。结果伴发快速房性心律失常高血压患者年龄大、病程长（P〈0．01），左房前后径、上下径、左右径均明显大于单纯高血压组；左房容积、容积指数亦显著大于单纯高血压组；但左房上下径／前后径、上下径／左右径、2×上下径／（前后径＋左右径）比值2组间无显著性差异。合并快速房性心律失常患者左室收缩末容量大于单纯高血压组，左室收缩末内径、左室质量指数在合并快速房性心律失常组有增高的趋势。结论与单纯高血压患者相比，高血压伴发快速房性心律失常患者左房重塑明显，容积及各径线增大，但几何构形未发生明显变化；左室重塑尚处于初始阶段，在收缩末期有向球形变化的趋势。     

Comparison of left atrial volume parameters in detecting left ventricular diastolic dysfunction versus tissue Doppler recordings

Because of diastolic coupling between the left atrium and left ventricle, we hypothesized that left atrial (LA) function mirrors the diastolic function of left ventricle. The aims of this study were to assess whether LA volume parameters can be good indexes of left ventricular diastolic dysfunction. Six hundred fifty-nine patients underwent cardiac catheterization and measurements of left ventricular filling pressure (LVFP). Echocardiographic examinations including tissue Doppler and LA volumes were also assessed. Ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity and LVFP tended to increase after progression of diastolic dysfunction. The inverse phenomenon existed in LA ejection and LA distensibility. LA distensibility was superior to LA ejection fraction and early diastolic mitral inflow velocity/early diastolic mitral annular velocity for identifying LVFP >15 mm Hg (areas under receiver operating characteristic curve 0.868, 0.834, and 0.759, respectively) and for differentiating pseudonormal from normal diastolic filling (areas under receiver operating characteristic curve 0.962, 0.907, and 0.741, respectively). Multivariate logistic regression showed that LA ejection fraction and LA distensibility were associated significantly with the presence of pseudonormal/restrictive ventricular filling. In conclusion, LA volume parameters can identify LVFP >15 mm Hg and differentiate among patterns of ventricular diastolic dysfunction. For assessing diastolic function LA parameters offer better performance than even tissue Doppler.     

老年冠心病患者冠状动脉病变程度及其侧支循环对左室舒张功能的影响

目的　探讨老年冠心病患者冠状动脉病变程度及侧支循环对左室舒张功能 (LVDF)的影响。方法　 6 8例选择性冠状动脉造影主要分支狭窄≥ 75 %的老年冠心病患者作Leaman冠状动脉记分 ,左室造影测左室射血分数 (LVEF) ,左室壁运动作Cortina记分 ,经胸多谱勒超声血流仪测LVDF ,研究侧支循环对Leaman冠状动脉记分与LVEF、LVDF及Cortina记分间关系的影响。结果　全组Leaman冠状动脉记分与LVEF及Cortina左室壁运动记分无相关 ,与LVDF相关。有侧支循环建立两亚组LVDF差异无显著性意义 ,无侧支循环建立两亚组LVDF差异有显著性意义。结论　老年冠心病患者冠状动脉病变程度与LVDF有关 ,侧支循环的建立对老年冠心病患者的LVDF有保护作用。     

高血压病心律失常发生机制的临床分析

目的分析高血压病心律失常的发生机制。方法对100例高血压病患者和20例健康者的超声心动图、24小时动态心电图和临床资料进行比较。结果(1)高血压病患者的左心房(左房)增大,并随年龄增大,高血压病史延长,左房扩大越明显,发生严重房性心律失常几率也越高。高龄组发生持续性房颤为30.77%,显著高于其他年龄组。(2)室性心律失常发生率为36%(36例),房性心律失常发生率为85%(85例)。(3)多元回归分析显示:高血压病患者房性心律失常的发生与左房的大小、二尖瓣返流、左室大小以及左室质量指数相关,尤其与左房大小的相关性更明显,室性心律失常与左房、二尖瓣返流、主动脉瓣返流、左室质量指数相关性不显著,而与左室腔大小相关。结论(1)年龄、高血压病史、左房大小是影响高血压房性心律失常的重要因素,二尖瓣返流、左室增大、左室质量指数增高也与发生房性心律失常相关。(2)高血压患者室性心律失常发生率低于房性心律失常,高血压离心性心脏扩大比向心性肥厚更容易发生室性心律失常。     

Effect of insulin resistance on left ventricular hypertrophy and dysfunction in essential hypertension.

BACKGROUND: In hypertensive patients, the relationships between glucose tolerance and left ventricular hypertrophy (LVH) and left ventricular diastolic function (LVDF) have been described in several reports. OBJECTIVE: In this study, we examined the relationships between insulin resistance and LVH and LVDF in hypertensive patients from the therapeutic perspective. METHODS AND RESULTS: The study participants were essential hypertensive patients with impaired glucose tolerance (IGT-HT, n = 26), hypertensive patients with normal glucose tolerance (NGT-HT, n = 39), and normotensive control individuals (n = 18). Insulin resistance was evaluated by the insulin suppression test by use of the steady-state plasma glucose (SSPG) level. Left ventricular mass index (LVMI) and LVDF, which was determined by the E:A ratio, were estimated by echocardiography. Temocapril, an angiotensin-converting enzyme inhibitor, was administered in an open, non-randomized manner with a mean dose of 2.8+/-0.2 mg/ day, and the mean administration period was 18 weeks. The systolic and diastolic blood pressure, the LVMI, and the SSPG level were significantly higher in the hypertensive patients than in the control individuals. The mean systolic and diastolic blood pressures were significantly decreased by treatment with Temocapril. Before treatment, stepwise regression analysis showed that SSPG is an independent predictor for LVMI and LVDF. After treatment, the changes in LVMI (D-LVMI; %) (-15.1+/-1.5), the changes in LVDF (D-E:A; %) (-38.2+/-4.1), and the changes in insulin resistance (D-SSPG; %) (-13.7+/-1.7) were significantly higher in the IGT-HT group than in the NGT-HT group (-11.4+/-1.1, -18.1+/-1.7, -9.4+/-1.4, respectively), and the D-SSPG was an independent predictor for D-LVMI and D-E :A. CONCLUSIONS: The results of this study indicate that insulin resistance is an important factor affecting LVH and LVDF.