原发性高血压左室肥厚患者冠状动脉粥样硬化狭窄特点

目的:探讨原发性高血压(EH)伴左室肥厚(LVH)患者冠状动脉粥样硬化狭窄特点。方法:选择经过冠状动脉造影的EH患者566例,伴LVH者140例(LVH组),与单纯EH患者426例(对照组)对比分析冠状动脉粥样硬化狭窄的部位、狭窄的程度、狭窄的范围等的差异。结果:LVH组与对照组比较,LVH组患者发生冠状动脉粥样硬化狭窄的概率明显升高(P<0.01),其危险性增加5.09倍。同时,LVH组发生左前降支冠状动脉粥样硬化狭窄概率显著高于对照组(P<0.01),在其他部位冠状动脉粥样硬化狭窄程度2组比较差异无统计学意义(P>0.05)。LVH组冠状动脉狭窄患者运动平板试验的心肌缺血检出率为33.1%(42/127),而对照组冠状动脉狭窄患者的心肌缺血检出率为12.5%(35/280),P<0.05。在传统冠状动脉粥样硬化危险因素中,只有血压与LVH存在协同效应(P<0.05)。结论:EH伴LVH患者冠状动脉粥样硬化狭窄发生率显著升高,左前降支是主要狭窄部位,而且更易于发生心肌缺血。

Characteristics of coronary atherosclerosis in patients with hypertensive left ventricular hypertrophy

Objective:To evaluate the features of coronary artery stenosis in patients with hypertensive left ventricular hypertrophy.Method:Five hundred and sixty-six patients with essential hypertension were divided into two groups after coronary angioplasty,one group(control group,n=426) with simple essential hypertension,another group(left ventricular hypertrophy,LVH,n=140)with left ventricular hypertrophy,and the difference of coronary artery stenosis between two groups were analyzed.Result:There were no differenas in the levels of blood pressure,age,blood glucose,blood triglyceride(TG) and low density lipoprotein (LDL) between the two groups.The coronary artery stenosis in patients with left ventricular hypertrophy increased significantly than that in patients with simple essential hypertension,and the incidence is 5.09 times higher in LVH than that in control group(P<0.01).The incidence of coronary artery stenosis happened on the anterior descending branch is more higher in patients of LVH group than in control group(P<0.01),whereas no significant difference on other sites' stenosis.And no distinction of coronary atherosclerosis' degree were found between the two groups.The incidence of myocardial ischemia detected by exercise test in the LVH group is significantly higher than that in control group.Moreover,left ventricular hypertrophy is independent of blood TG,LDL,and blood sugar,but correlated with blood pressure to induce the coronary artery stenosis.Conclusion:The total incidence of coronary artery atherosclerosis is increased markedly,and the left anterior descending branch is the main sites of atherosclerosis,in patients with essential hypertension accompanied by left ventricular hypertrophy,and the incidence of myocardial ischemia is more higher in these patients.