高龄老年高血压患者左室肥厚的相关因素研究

目的对高龄老年高血压患者左室肥厚的相关因素进行分析。方法对168例高龄老年高血压患者〔年龄(85.4±5.0)岁〕进行超声心动图检查和动态血压监测,按Devereux公式计算左心室质量指数(LVMI)。将患者分为左室肥厚组(n=74)和非左室肥厚组(n=94),对比分析两组间临床资料和动态血压参数的差异。以LVMI为因变量,进行多元逐步回归分析。结果 (1)左室肥厚组的高血压病程、三酰甘油、空腹血糖、空腹胰岛素、血尿酸、平均收缩压(24 h、白天、夜间)、脉压和24 h收缩压变异系数均明显高于非左室肥厚组,差异有统计学意义(P<0.05);两组非杓型血压节律者分别为56.7%和31.9%,差异有统计学意义(P<0.05);两组间血脂、平均舒张压和24 h舒张压变异系数比较,差异均无统计学意义(P>0.05)。(2)多元线性逐步回归分析显示,LVMI依次与白天平均收缩压、夜间平均收缩压、24 h收缩压变异系数、空腹胰岛素密切相关(R2=0.511,P<0.05)。结论高龄高血压病患者LVMI与多种因素相关,有效控制白天和夜间的收缩压,降低血压变异性和胰岛素抵抗,可能对改善左室肥厚有益。

Study on the Related Factors about Left Ventricular Hypertrophy in Very Elderly Hypertensive Patients

Objective To explore the related factors of left ventricular hypertrophy in very elderly hypertensive patients.Methods 168 very elderly hypertensive patients(85.4±5.0) underwent echocardiography and 24 hour ambulatory blood pressure monitoring.Left ventricular mass index were calculated with Devereux′s formula.Classified the patients as group with left ventricular hypertrophy(LVH,n=74) and group without left ventricular hypertrophy(NLVH,n=94).Clinical general data and ambulatory blood pressure monitoring parameters were compared within groups.Multiple linear regression analysis was used for statistical analysis,LVMI being the dependent variable.Results(1)In the LVH group,the duration of hypertension,triglyceride,fast glucose,fast insulin,uric acid,mean systolic blood pressure(24 hour,daytime,nighttime),pulse pressure(24 hour,daytime,nighttime) and 24 hour systolic blood pressure variability were significantly higher than those in the NLVH group.The difference was significant(P<0.05).The non-dipper rhythm of ambulatory blood pressure were 56.7% vs 31.9%(P<0.05);There were no significant difference in blood lipid,mean diastolic blood pressure and 24 hour diastolic blood pressure variability between the LVH and NLVH groups(P>0.05).(2)Multiple linear stepwise regression analysis showed that LVMI significantly correlated with daytime mean systolic blood pressure,nighttime mean systolic blood pressure,24 hour systolic blood pressure variability and fast insulin(R~2=0.511,P<0.05).Conclusion LVMI of very elderly hypertensive patients was associated with many factors independently.Controlling daytime and nighttime systolic blood pressure effectively,improving systolic blood pressure variability and insulin resistance may be helpful to inhibit left ventricular hypertrophy.