组织多普勒成像评价血压昼夜节律变异对左心室舒张功能的影响

目的探讨血压昼夜节律变异对左心室舒张功能的影响。方法31例非杓型高血压患者(非杓型组)和31例年龄、性别相匹配的杓型高血压患者(杓型组)入选。两组患者均行24 h动态血压监测和组织多普勒成像(DTI)检查。结果两组日间平均收缩压和平均舒张压无显著性差异,非杓型组的夜间平均收缩压和平均舒张压均显著高于杓型组(145.1±34.5)mm Hg(1 mm Hg=0.133 kPa)vs(127.9±18.1)mm Hg,(94.2±38.1)mm Hgvs(78.5±18.2)mm Hg,P<0.05]。心脏超声检查显示两组在心腔内径、室壁厚度和左心室射血分数等参数无显著性差异,DTI结果显示非杓型组的平均组织舒张早期速度(MEa)、MEa/平均组织舒张晚期速度(MAa)显著低于杓型组(5.9±2.1)cm/svs(7.8±3.1)cm/s,(0.68±0.56)cm/svs(0.95±0.39)cm/s,P<0.05和P<0.01)];非杓型组的MAa较杓型组明显升高(9.5±2.8)cm/svs(8.6±1.7)cm/s,P<0.01]。结论血压昼夜节律变异可加重左心室舒张功能受损。对于存在血压昼夜节律变异的高血压患者应尽早诊断,积极治疗和加强随访。

Assessment of impact of blood pressure circadian variation on left ventricular diastolic function in essential hypertension by tissue Doppler imaging

Objective To assess the impact of blood pressure(BP) circadian variation on left ventricular diastolic function in essential hypertension.Methods Thirty-one patients with non-dipper-type hypertension(non-dipper group) and 31 age-and sex-matched patients with dipper-type hypertension(dipper group) were enrolled.They underwent 24 h-ambulatory blood pressure monitoring and color tissue Doppler imaging.Results The nocturnal systolic and diastolic BPs were higher in non-dipper group than in dipper group(145.1±(34.5)) vs(127.9±18.1),(94.2±38.1) vs(78.5±18.2) mm Hg,P<(0.05)].The two groups did not differ regarding left atrial diameter,interventricular septum thickness,posterior wall thickness,ejection fraction,and left ventricular mass index.The mean left ventricular diastolic velocities differed significantly between the 2 groups.The early diastolic velocity(MEa) decreased (5.9±2.1) vs(7.8±3.1) cm/s,P<(0.05)],the late diastolic velocity(MAa) increased (9.5±2.8) vs(8.6±1.7) cm/s,P<(0.01)],and the MEa/MAa ratio decreased (0.68±0.56) vs(0.95±0.39),P<0.01] in non-dipper group as compared with dipper group.Diastolic LV function was reduced significantly in non-dipper cases.Conclusions These findings may provide clinically important information about the relationship between myocardial diastolic function and circadian variation of blood pressure in patients with essential hypertension,which suggests that non-dipper-type hypertensive patients who have impaired left ventricular diastolic function should be identified early for careful follow-up and treatment.