彩色多普勒评价高血压左心室舒张功能的价值

目的　探讨多普勒组织成像 (DTI)技术评价高血压病 (EH)患者左心室舒张功能的价值 ,以寻求一种可靠、客观的评价高血压左心室舒张功能的新方法。方法　采用放免法测定 2 0例正常人和 4 2例 EH患者 (伴心肌肥厚者2 0例和不伴心肌肥厚者 2 2例 )的血清 I型前胶原 (PC )和 型前胶原 (PC )的浓度。用 DTI法检测正常人及 EH患者二尖瓣环舒张早期运动速度 (Ea)、舒张晚期运动速度 (Aa)及 Ea/Aa,并用二尖瓣血流多普勒法检测舒张期血流速度 E、A及 E/A,比较两种方法测值与血清 PC 、PC 型前胶原的相关性。结果　 1.EH患者非左心室肥厚(non- L VH )组及左心室肥厚 (L VH )组二尖瓣口血流参数、二尖瓣环 DTI参数均明显低于正常对照组 (P<0 .0 1) ;2 .EH患者 non- L VH组与 L VH组间 E、E/A无明显差异 (P>0 .0 5 ) ,但 L VH组 Ea、Ea/Aa明显低于 non- L VH组(P<0 .0 5 ) ;3.EH患者 non- L VH组血清 PC 、PC 与 E/A及 Ea/Aa均呈负相关 ;而 L VH组血清 PC 、PC 与Ea/Aa亦呈负相关 ,与 E/A无明显相关。结论　 DTI能更准确定量高血压患者二尖瓣环舒张期运动速度的改变 ,DTI法检测二尖瓣环运动速度之比与反应心肌纤维化程度的血清 PC 、PC 浓度相关良好 ,有利于舒张功能受损程度的判断 ,优于传统的二尖瓣口血流法。

Value of evaluating left ventricular diastolic function by color echocardiogrophy in hypertensive patients

Objective To evaluate left ventricular diastolic function(LVDF)by Doppler tissue imaging(DTI) in patients with essential hypertension(EH). Methods Serum procollagen I(PCⅠ) and procollagenⅢ(PCⅢ)were measured by radioimmuoassay in 42 EH patients and 20 normal volumteers. Ea, Aa, Ea/Aa were measured by DTI in EH patients and normal group. The diastolic flow velocity E.A. E/A were measured by transmitral valve Doppler flow. Results Mitral valve flow parameters and mitral anulus parameters by DTI were decreased significantly (P<0.01)in hypertensive patients with non-left ventricular hypertrophy (LVH) and LVH. E. E/A.were no significant difference(P>0.05) in EH patients between non-LVH and LVH,A negative correlations were found betweenPCⅠ or PCⅢ and E/A. Ea/Aa in EH patients with non-LVH group.Conclution The alteration of DTI was closely related to serum concentration of PCⅠ and PCⅢ for asses myocardial fibrosis in EH patients. DTI can be used as objective parameter for diagnosis of LVDF in EH patients.