2型糖尿病合并原发性高血压患者的动态血压及脉压和左心室结构功能的关系

目的 :探讨 2型糖尿病 (DM)、原发性高血压 (EH)及DM +EH时 2 4小时动态血压和脉压的变化特点及与左心室结构和功能的关系。　　方法 :将 2 45例患者分为DM组 (n =72 )、EH组 (n =96)及DM +EH组 (n =77) ,进行动态血压及超声心动图检查。　　结果 :DM +EH组全天收缩压、全天脉压、左心室重量显著大于DM组及EH组 (P <0 0 5 )。左心室射血分数、短轴缩短率、舒张早期血流峰值速度 /舒张晚期血流峰值速度 (E/A)值、等容舒张时间 3组间无显著差异。相关分析表明 ,DM组左心室重量和全天脉压相关 (P <0 0 1) ;EH组左心室重量和全天收缩压相关 (P <0 0 5 ) ;DM +EH组左心室重量和全天收缩压及全天脉压相关 (P <0 0 5 )。 3组左心室舒张功能异常患者的全天收缩压、全天脉压均显著高于左心室舒张功能正常患者 (P均 <0 0 5～ 0 0 1) ,左心室的收缩功能正常患者和异常患者比较 ,2 4小时动态血压和脉压值均无显著差异 (P均 >0 0 5 )。　　结论 :DM组、EH组和DM +EH组 3组患者全天收缩压、全天脉压及左心室重量有显著差异 ,左心室重量和血压及脉压的相关性在 3组患者中不完全一致 ,可能与 3组患者体液及压力因素在左心室肥厚中的作用各不相同有关。

Impact of Ambulatory Blood Pressure Monitor and Pulse Pressure on Left Ventricular Structure and Function in Type 2 DM With Hypertension

Objective:To investigate the characteristics of 24 h ambulatory blood pressure and pulse pressure of type 2 diabetes mellitus(DM) with or without hypertension and their correlation with left ventricular structure and function. Methods:Two hundred fourty five patients were divided into essential hypertension(EH,n=96),type 2 DM(n=72),or hypertensive DM(n=77)group.Color Doppler echocardiogram and 24 h ambulatory blood pressure monitoring were observed in all patients. Results:Twenty four hour systolic blood pressure(SBP24h),and 24 hour pulse pressure(PP24h)were significantly increased in hypertensive DM compared with type 2 DM or EH.So was the left ventricular mass(LVM)(p<0 05).The percentage of cardiac systolic or diastolic dysfunction was significantly low in hypertensive DM compared with EH or type 2 DM.By regression analysis,LVM was related to PP24h in type 2 DM, SBP24h in EH,SBP24h and PP24h in hypertensive DM.SBP had marked impact on left ventricular diastolic function but no impact on left ventricular systolic function. Conclusion:Characteristics of SBP24h and PP24h among patients with type 2 DM, EH and hypertensive DM were quite different.Left ventricular mass was not always correlated with SBP and PP among the three groups, which may be associated with different damage of cardiac structure and function by body fluid and blood pressure.