左室内血流传播速度对高血压患者左室舒张功能的评价

目的:应用彩色M型多普勒超声心动图测量舒张早期左室内血流传播速度(Vp),评价高血压(EH)患者左室舒张功能,以寻求一种可靠客观的评价高血压左室舒张功能的方法。方法:采用放免法测定19例正常人和41例EH患者(伴心肌肥厚者19例和不伴心肌肥厚者22例)的血清Ⅰ型前胶原(PCⅠ)和Ⅲ型前胶原(PCⅢ)的浓度,用彩色M型多普勒超声心动图测量左室内血流传播速度(Vp),并用血流多普勒法检测二尖瓣口舒张期血流速度E峰、A峰及E/A值,比较两种方法测值与PCⅠ、PCⅢ的相关性。结果:1.EH患者非左室肥厚组(non-LVH)与左室肥厚组(LVH)PCⅠ、PCⅢ明显高于正常对照组(P<0.01),其中LVH组PCⅠ明显高于non-LVH组(P<0.05)。2.EH患者非左室肥厚组(non-lVH)与左室肥厚组(LVH)二尖瓣血流参数,Vp均明显低于正常对照组(P<0.05)。3.EH患者non-LVH组与LVH组间E、E/A无明显差别(P>0.05),但LVH组Vp明显低于non-LVH组(P<0.05)。4.EH患者non-LVH组血清PCⅠ、PCⅢ与E/A及Vp均呈负相关(r=-0.58P<0.01,r=-0.61P<0.01及r=-0.67P<0.01,r=-0.51P<0.05);而LVH组血清PCⅠ、PCⅢ与Vp亦呈负相关(r=-0.69P<0.05,r=-0.65P<0.01);与E/A无明显相关(r=-0.41P>0.05,r=0.02P>0.05)。结论:左室内血流传播速度与反应心肌纤维化程度的血清PCⅠ、PCⅢ浓度相关良好,不受心脏负荷及年龄的影响,作为评价高血压病人左室舒张功能的指标有临床意义。

Assessment of Diastolic Function in Hypertensive Patients by Left Ventricular Flow Propagation Velocity

Objective To evaluate the Left Ventricular function in the patients with hypertension.The propagation velocity(Vp) of early flow into the left ventricular cavity was measured by color M-mode Doppler echocardiography.Methods Fourty-one essential hypertensive patients19 pationts with left ventricular hypertrophy(LVH) and 22 pationts with left ventricular hypertrophy(non-LVH)]and 19 normotensive control subjects(NT) were enroned.]The serum concentrations of procollagen typel(PCⅠ) and procollagen Ⅲ(PCⅢ) in all three groups were measured by specific radioimmunoassay.Vp of early flow into the left Veutricular cavity in normal and hypertensive patients were mearsured by color M-mode Doppler echocardiography and also mitral inflow velocity E、A by Doppller flow imaging were detected.Then We analysed the correlation between thses Doppler inderes and the serum PC Ⅰ and PC Ⅲ.Results 1.Serum concentration of PCⅠ and PCⅢ were increased in patients of non-LVH and LVH compared with NT(P<0.01).The serum PCⅠ of the LVH was increased in the patients with non-LVH(P<0.05).2.The E、E/A Vp of hypertensive patients in non-LVH and LVH were lower than NT(P<0.05).3.No significant difference was noted between E、E/A of the non-LVH and LLVH(P<0.05).The Vp of patients with LVH were lower than those of non-LVH(P<0.05).4.Serum Concentration of PCI and PC Ⅲ were negatively correlated with E/A and Vp in the patients with those of non-LVH(r=0.58 P<0.01,r=-0.61 P<0.01 and r=-0.67 P<0.01,r=-0.51 P<0.05)respectively.Serum Concentration of PCI and PC Ⅲ were negatively correlated with Vp in the patients with LVH(r=-0.69,P<0.01,r=-0.65,P<0.01)respectively and they were not correlated with E/A(r=-0.41,P>0.05,r=0.02,P>0.05) respectively.Conclusion:Vp was better correlated with serum concentration of PCI and PCⅢ and was not affected by cardiac load and age.It may have clinical significance as an index in evaluating left ventricular diastolic function of patients with hypertension.