高血压病患者左房左室重构的关系及参与因素
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摘要
目的：探讨高血压病患者左房重构性变化、影响因素及其程度，及其与左室结构功能变化的关系。
方法：以切面及多普勒超声法检测89例轻中度高血压病患者左房大小及左室结构和功能指标。通过多元逐步回归分析，甄选影响左房大小的独立影响因素，并以协方差分析校正其他因素的混杂影响后，比较不同左室构型组左房内径差异，正常血压者82例为对照。
结果和结论：左房内径与收缩压水平、左室壁厚度或肌重量、以及左室舒张功能指标间存在显著性多元复相关和直线相关关系：血压，主要是收缩压水平越高，左室壁越厚，左室舒张功能损害越甚，左房就越大。此外，影响高血压病左房构形的其他因素尚有超重或肥胖程度、心率等，在评估高血压病左房构形变化时应予关注。
Objects: To investigate the remodeling changes of left atrium, correlative factors and the relationship between changes of left atrial size and changes of left ventricular structure and function in essential hypertensive patients.
Methods: The dimension of left atrium and indices of left ventricular structure, systolic and diastolic functions were measured by Two-dimensional and Doppler echocardiography in 89 mild to moderate hypertensive patients.
The independent factors effecting on the dimension of left atrium were identified by method of multivariance stepwise regression analysis. After adjusting for the confounding effects of other variables by covariance analysis, the differences of the dimension of left atrium among the different left ventricular remodeling pattern groups were compared with 82 normotensive subjects as a control.
Results and Conclusion: The results of multivariance analysis showed that there was a statistically significant multiple and linear correlation between the dimension of left atrium and systolic blood pressure, thickness of left ventricular wall or left ventricular mass, and indices of left ventricular diastolic functions. If the systolic blood pressure level is higher, the left ventricular wall is thicker, and the left ventricular diastolic function is worse, the dimension of left atrium would be larger. Moreover the overweight or obesity, heart rate were found to be the affecting factors on size of left atrium as well and would be considered in those studies on left atrial structure in essential hypertensive patients.
方法：以切面及多普勒超声法检测89例轻中度高血压病患者左房大小及左室结构和功能指标。通过多元逐步回归分析，甄选影响左房大小的独立影响因素，并以协方差分析校正其他因素的混杂影响后，比较不同左室构型组左房内径差异，正常血压者82例为对照。
结果和结论：左房内径与收缩压水平、左室壁厚度或肌重量、以及左室舒张功能指标间存在显著性多元复相关和直线相关关系：血压，主要是收缩压水平越高，左室壁越厚，左室舒张功能损害越甚，左房就越大。此外，影响高血压病左房构形的其他因素尚有超重或肥胖程度、心率等，在评估高血压病左房构形变化时应予关注。
Objects: To investigate the remodeling changes of left atrium, correlative factors and the relationship between changes of left atrial size and changes of left ventricular structure and function in essential hypertensive patients.
Methods: The dimension of left atrium and indices of left ventricular structure, systolic and diastolic functions were measured by Two-dimensional and Doppler echocardiography in 89 mild to moderate hypertensive patients.
The independent factors effecting on the dimension of left atrium were identified by method of multivariance stepwise regression analysis. After adjusting for the confounding effects of other variables by covariance analysis, the differences of the dimension of left atrium among the different left ventricular remodeling pattern groups were compared with 82 normotensive subjects as a control.
Results and Conclusion: The results of multivariance analysis showed that there was a statistically significant multiple and linear correlation between the dimension of left atrium and systolic blood pressure, thickness of left ventricular wall or left ventricular mass, and indices of left ventricular diastolic functions. If the systolic blood pressure level is higher, the left ventricular wall is thicker, and the left ventricular diastolic function is worse, the dimension of left atrium would be larger. Moreover the overweight or obesity, heart rate were found to be the affecting factors on size of left atrium as well and would be considered in those studies on left atrial structure in essential hypertensive patients.
引文
[1] Ganau A, Devereux R B, Roman M J, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992.19: 1550-1558
[2] 王兆禹，李佐才，张开宁，等．高血压病患者右心室结构和功能的变化及相关因素分析．心功能杂志，1999，11(2)：91-94
[3] Matsuda M, Matsuda Y. Mechanism of left atrial enlargement related to ventricular diastolic impairment in hypertension. Clin-Cardiol, 1996, 19(12): 954-959
[4] Gottdiener JS, Reda DJ, Williams DW, et al. Left atrial size in hypertensive men: influence of obesity, race and age. J Am Coll Cardiol, 1997, 29(3): 651-658
[5] 朱向明，章辉，赵振东．高血压病左房构形及功能变化的超声研究进展．心血管病学进展，2000，21(1)：43-45
[6] 王小涛，方平，罗在明，等．左房增大的高血压病患者的左室舒张功能变化．中华心血管病杂志，1990．18(5)：265-267
[7] 龚兰生，于金德，张大东，等．高血压病患者左房增大和左室舒张功能的变化．临床心血管病杂志，1991，7(4)：202-205
[8] 胡镇祥，郑知刚，王明屹，等．高血压病左房扩大的意义及其相关因素．心肺血管病杂志，1994，13(2)：69-72
[9] 李松柏，索文霞，刘仁瑜．高血压病患者左房内径增大与左心结构改变的关系探讨．临床心血管病杂志，1995，11(3)：135-137
[10] Roman M J, Pickering T G, Schwarts J E, et al. Relation of arterial structure and function to left ventricular geometric patterns in hypertensive adults. J Am Coll Cardiol, 1996, 28:751-756
[11] 马彩娥，吕发勤，杜丽，等．高血压病早期左房结构改变的意义及与心舒张功能的关系．中国超声医学杂志，1998，14(11)：63-64
[12] 王岳恒，王玉芳，张继增，等．高血压病患者左房容积改变及其影响因素．中国循环杂志，1993，8(8)：456-457
[13] Gerdts EV, Oikarinen LA, Palmieri, et al. Correlates of left atiral size in hypertensive patients with left ventricular hypertrophy, the losartan intervention tor endpoint reduction in hypertension. Hypertension, 2002, 39:739-749
[14] Tsang TS, Barnes ME,Gersh BJ, et al. Left atrial volume as a morphophysiohogic expression of left ventricular diastolic dysfunction and to cardiovascular risk burden Am-J-Cardiol, 2002, 90(12): 1284-9
[2] 王兆禹，李佐才，张开宁，等．高血压病患者右心室结构和功能的变化及相关因素分析．心功能杂志，1999，11(2)：91-94
[3] Matsuda M, Matsuda Y. Mechanism of left atrial enlargement related to ventricular diastolic impairment in hypertension. Clin-Cardiol, 1996, 19(12): 954-959
[4] Gottdiener JS, Reda DJ, Williams DW, et al. Left atrial size in hypertensive men: influence of obesity, race and age. J Am Coll Cardiol, 1997, 29(3): 651-658
[5] 朱向明，章辉，赵振东．高血压病左房构形及功能变化的超声研究进展．心血管病学进展，2000，21(1)：43-45
[6] 王小涛，方平，罗在明，等．左房增大的高血压病患者的左室舒张功能变化．中华心血管病杂志，1990．18(5)：265-267
[7] 龚兰生，于金德，张大东，等．高血压病患者左房增大和左室舒张功能的变化．临床心血管病杂志，1991，7(4)：202-205
[8] 胡镇祥，郑知刚，王明屹，等．高血压病左房扩大的意义及其相关因素．心肺血管病杂志，1994，13(2)：69-72
[9] 李松柏，索文霞，刘仁瑜．高血压病患者左房内径增大与左心结构改变的关系探讨．临床心血管病杂志，1995，11(3)：135-137
[10] Roman M J, Pickering T G, Schwarts J E, et al. Relation of arterial structure and function to left ventricular geometric patterns in hypertensive adults. J Am Coll Cardiol, 1996, 28:751-756
[11] 马彩娥，吕发勤，杜丽，等．高血压病早期左房结构改变的意义及与心舒张功能的关系．中国超声医学杂志，1998，14(11)：63-64
[12] 王岳恒，王玉芳，张继增，等．高血压病患者左房容积改变及其影响因素．中国循环杂志，1993，8(8)：456-457
[13] Gerdts EV, Oikarinen LA, Palmieri, et al. Correlates of left atiral size in hypertensive patients with left ventricular hypertrophy, the losartan intervention tor endpoint reduction in hypertension. Hypertension, 2002, 39:739-749
[14] Tsang TS, Barnes ME,Gersh BJ, et al. Left atrial volume as a morphophysiohogic expression of left ventricular diastolic dysfunction and to cardiovascular risk burden Am-J-Cardiol, 2002, 90(12): 1284-9