原发性高血压患者左室构型与颈动脉粥样硬化的关系

目的:探讨原发性高血压(EH)患者左室构型(LVG)与颈动脉粥样硬化(CAS)之间的关系。方法:原发性高血压106例,按Ganau分类法分为4型:正常构型(Ⅰ组)28例、向心性重构(Ⅱ组)32例、向心性肥厚(Ⅲ组)26例及离心性肥厚(Ⅳ组)20例;正常对照组30例。采用美国超声协会推荐的方法测量室间隔(I VS)、左室后壁厚度(LVPW)、左室舒张末内径(LVDd),计算左室重量指数(LVMI)。同时超声测量颈总动脉内中膜厚度(I MT)、观察有无颈动脉斑块形成,从而判断有无颈动脉粥样硬化。结果:颈总动脉的I MT在Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组呈递增趋势,均高于正常对照组,且Ⅲ组、Ⅳ组显著高于Ⅰ组、Ⅱ组及正常对照组(P<0.05);Ⅱ组与Ⅰ组及正常对照组间差异亦有统计学意义(P<0.05);原发性高血压各组CAS的检出率明显高于正常对照组,变化与颈总动脉I MT基本一致;同时高血压病患者LVMI与颈动脉粥样硬化形成间有显著正相关(r=0.55,P<0.05)。结论:颈动脉粥样硬化的发生与原发性高血压左室构型密切相关。

Relationship Between Left Ventricular Geometry and Carotid Atherosclerosis in Essential Hypertension

Objective:To investigate the relationship between left ventricular geometry and carotid atherosclerosis in patients with essential hypertension. Methods:One hundred and six patients with essential hypertension were enrolled. According to Ganau categories, these patients were divided into four groups as follows: normal left ventricle (group Ⅰ,28 cases), concentric remodeling ( group Ⅱ,32 cases), concentric hypertrophy (group Ⅲ, 26 cases) and eccentric hypertrophy ( group Ⅳ, 20 cases), and 30 age- matched healthy subjects as the control group were included.The end-diastolic diameters of the left ventricle(LVDd),interventricular septum thickness (IVS), left ventricular posterior wall thickness(LVPW), left ventricular myocardial mass index (LVMI)were detected with echocardiography. A Color Doppler Ultrasound system was used to investigate the intimal-medial thickness(IMT) of the common carotid artery(CCA) and the plaque of the carotid artery. Results:The positive rate of carotid atherosclerosis found in the patients with essential hypertension was remarkably higher than that in the normal controls. IMT of the commom carotid artery of all patients was increased greater than that of the normal. There was significant difference between GroupsⅢ and Ⅳ and Groups Ⅰand Ⅱ, and the normal as well as between GroupsⅡ and Ⅰ,and the normal (P<0.05) .The carotid atherosclerosis was significantly correlated with LVMI in patients with essential hypertension (r=0.55,P<0.05). Conclusions:The carotid atherosclerosis was closely related to the left ventricular geometry in patients with essential hypertension.