· 临床研究·

    基金项目:卫生部资助项目(WKZ 2200021203)

    作者单位:250012 济南,山东大学齐鲁医院心内科

    高血压病左心室质量和舒张功能改变

    与内分泌因子的关系

    张梅 方永奇 张运 蔡恒 郭媛 安丰双 卜培莉 葛志明 黎莉

    【摘要】 目的 应用二维及组织多普勒超声( TDI)技术探讨高血压病患者左心室质量和舒张功能与内分泌

    因子的关系。方法 61 例高血压病患者根据超声心动图测量左室质量指数 (LVMI) 分为左室心肌肥厚组

    (LVH ,30例)和非左室心肌肥厚组(NLVH ,31例) 。20 例健康者为对照组。组织多普勒测量二尖瓣环心肌舒张

    早期峰值运动速度(e) 、晚期峰值运动速度(a)及其比值(e/ a) 。放射免疫法分析血浆心钠素(ANP) 、脑钠素

    (BNP) 、内皮素( ET) 、降钙素基因相关肽(CGRP)及血清胰岛素样类生长因子21 ( IGF21)的浓度。结果 高血压

    病LVH组与 NLVH组及对照组比较 ,e 波峰值速度降低 , [分别为(14. 56 ±7. 83) cm/ s、 (16. 40 ±0. 66) cm/ s、(18. 68±3. 78) cm/ s ] ,a 波峰值速度增高 , [分别为(18. 28 ±9. 60) cm/ s、 (16. 03 ±5. 88) cm/ s、 (14. 53 ±1. 28)

    cm/ s ] ;LVH和 NLVH组的 e波及 a波峰值速度与对照组比较 ,差异有显著性意义( P < 0. 05) ;对照组、高血压

    病 NLVH组、 LVH组二尖瓣侧环e/ a值依次显著减小(1. 42±0. 11 ,0. 88 ±0. 12 ,0. 74 ±0. 09 , P < 0. 001) 。对照

    组、高血压病NLVH组、 LVH组血浆 ET、 ANP、 BNP及血清 IGF21 浓度依次显著升高( P < 0. 001) ;对照组、高血

    压病 NLVH组、 LVH组血浆 CGRP浓度依次显著降低( P < 0. 001) 。ET与 e/ a 显著负相关( r = - 0. 79 , P <

    0. 01) ;ANP、 BNP、 IGF21 与 e/ a中度负相关( r分别为 - 0. 62、 - 0. 56、 - 0. 61 , P < 0. 01) ;CGRP与 e/ a 中度正

    相关( r = 0. 60 , P < 0. 01) 。结论 高血压病左室结构和舒张功能异常与 5 种内分泌因子改变均有较好的相关

    性 ,表明内分泌因子在高血压病左室质量和舒张功能的异常改变中具有重要作用。

    【关键词】 超声心动描记术;高血压;心室功能 ,左;肽类

    Relations between left ventricular ma ss ,dia stolic function and endocrine factors in e ssential h ypertension ZHA N G

    Mei , FA N G Yong2qi , ZHA N G Yun , et al . Department of Cardiology , Qilu Hospital of S handong University , Jinan

    250012 , China

    【Abstract】 Objective To study the changes of diastolic function of left vent ricle by tissue Doppler imaging

    ( TDI) and the serum level of endocrine factors ,and analyse the relations between these factors and mass or diastolic

    function of left vent ricle in patients with essential hypertension. Methods Sixty2 one patients with essential

    hypertension were divided into left vent ricular hypert rophy (LVH) group and no left vent ricular hypert rophy (NLVH)

    group . Twenty healthy subjects were considered as cont rol group. The early(e) and late (a) diastolic maximal myocardial

    velocity and e/ a of lateral wall motion of mit ral valve annulus were recorded b y TDI. The levels of at rial nat ritic peptide

    (ANP) , brain nat riuretic peptide (BNP) , endothelium ( ET) , calcitonic gene2related peptide (CGRP) and insulin2like

    growth factor21 ( IGF21) were measured by radio2immunology analysis. Re sults The e wave maximal velocity in LVH

    group was lower than that of NLVH group and cont rol group [ (14. 56±7. 83) cm/ s , (16. 40 ±0. 66) cm/ s , (18. 68±

    3. 78) cm/ s ,respectively ] , and a wave maximal velocity in LVH group was higher than that of NLVH group and

    cont rol group [ ( 18. 28 ±9. 60) cm/ s , ( 16. 03 ±5. 88) cm/ s , ( 14. 53 ±1. 28) cm/ s , respectively ] ; The e and a

    maximal velocity velocities in both LVH and NLVH groups had statistic differences with those of cont rol group ( P <

    0. 05) . The e/ a of wall motion of mit ral valve annulus decreased gradually in cont rol group ,NLVH group and LVH

    group (1. 42 ±0. 11 ,0. 88 ±0. 12 ,0. 74 ±0. 09 , P < 0. 001) . ET ,ANP ,BNP and IGF 21 all increased in NLVH group

    ( P < 0. 001) and increased further in LVH group , while CGRP decreased in NLVH group ( P < 0. 001) and

    decreased further in LVH group. There were moderate correlations between the endocrine factors with e/ a( r = 0. 60 ,P < 0. 01) . Conclusions The decreased diastolic function of left vent ricle assessed b y TDI correlates with changes of

    the endocrine factors in the patients with hypertension.

    【Key words】 Echocardiography ; Hypertension ;Vent ricle function ,left ; Pe ptides

    · 588 · 中华超声影像学杂志2004 年12 月第13 卷第12 期 Chin J Ult rasonogr ,December 2004 ,Vol 13 ,No. 12

    ? 1995-2005 Tsinghua Tongfang Optical Disc Co., Ltd. All rights reserved. 许多研究证明高血压病患者在左心室收缩功能和

    心脏结构正常时就可出现左心室舒张功能的异

    常[1 ,2 ] ......