摘要
目的:研究高血压伴房颤患者左心重构及其功能特点、临床意义,对高血压患者发生房颤的危险因素做初步探讨。方法:依据JNC7高血压诊断标准和ACC/AHA/ESC 2006房颤指南诊断标准(AC标准)分为:将原发性高血压患者、单纯房颤患者以及高血压伴房颤患者分为:高血压伴房颤组224例(男120例,女104例),原发性高血压组171例(男97例,女74例),单纯房颤组166例(男90例,女76例),对照组为健康体检者157例(男93例,女64例)。采用GE Vivid 7彩色多普勒超声心动图仪测量各心腔结构和功能。变量以均数±标准差表示,采用SPSS12.0统计软件包进行数据分析,离散性资料采用非参数检验,计量资料采用单因素方差分析,计数资料采用2×2析因设计的方差分析。p<0.05表示差异有统计学意义。结果:1、四组间年龄无统计学差异。高血压组与高血压伴房颤组的收缩压、舒张压、高血压病程、房颤组与高血压伴房颤组的房颤病程无统计学差异。高血压组与高血压伴房颤组的收缩压、舒张压明显高于对照组和房颤组,有统计学差异(p<0.05)。2、单纯房颤组及高血压伴房颤组中,房颤类型主要是阵发性房颤,分别达到75%及69.2%。3、四组间IVSTd、LVPWTd、LVESD、LVEDD、LAD、RWT值均以高血压伴房颤组最大,其中高血压对上述各项数值均具有影响作用(p<0.05);房颤对IVSTd、LVEDD、LAD及RWT值具有影响作用(p<0.05);而高血压及房颤两因素对LVESD、LAD及RWT均具有交互效应(p<0.05)。4、四组间LVM、LVMI、SV、CO值均以高血压伴房颤组最大;高血压伴房颤组FS及LVEF明显低于其他三组,有统计学差异(p<0.05)。其中高血压对LVM、LVMI、LVEF值具有影响作用(p<0.05);房颤对LVM、LVMI、SV、FS及LVEF值有影响作用(p<0.05);而高血压及房颤对LVM、LVMI、FS及LVEF值具有交互效应(p<0.05)。结论:1、高血压或房颤发生时,患者的左心结构及功能亦发生改变,高血压合并房颤时这种变化则更为显著。2、高血压导致的左心重塑是高血压患者发生房颤的危险因素。
Objective: To study the characteristics of left heart remodelin and function and its clinical significance in hypertensive patients with atrial fibrillation;to predict some risk factors of atrial fibrillation.Methods:According to ACC/AHA/ESC 2006 the guideline of diagnostic criteria of AF and JNC7 the diagnostic criteria of hypertension,hypertensive patients,atrial fibrillation patients and essential hypertension with atrial fibrillation patients who were divided into 4 groups:essential hypertension with AF group including 224 patients (120 men and 104 women),essential hypertension group including 171 patients(97 men and 74women), AF without essential hypertension group including 166 patients(90 men and 76 women) and the normal control group including 157 healthy subjects(93 men and 64 women). Cardiac structure and function were assessed by means of echocardiography using GE Vivid 7 color doppler ultrasound scanner. SPSS 12.0 statistical software was used and data were analyzed. Quantitative data were expressed as mean±standard deviation. Analysis of variance was used for the comparison of mean among four groups. Analysis of variance of factorial design was used for enumeration data. The significance difference was defined as p <0.05.Results:1.SBP、DBP in the essential hypertension group and the essential hypertension with AF group were higher than that in the normal control group and the AF group(p<0.05).2.In the essential hypertension group and the essential hypertension with AF group, the main category of AF is the paroxysmal AF.3.IVSTd、LVPWTd、LVESD、LVEDD、LAD、RWT in the essential hypertension with AF group were significantly greater than those in the other groups(p<0.05),LVESD、LAD及RWT are influenced by the AF and the essential hypertension. 4.LVM、LVMI、SV and CO in the essential hypertension with AF group were significantly greater than those in the other groups(p<0.05). LVEF in the essential hypertension with AF group was significantly lower than those in the other groups (p<0.05). LVM、LVMI、FS and LVEF are influenced by the AF and the essential hypertension.Conclusion:1.Left ventricular function and structure changed in the hypertension or atria fibrillation patient. More severe change was found in hypertensive patients with atrial fibrillation.2.Left Heart Remodeling that was caused by hypertension is the risk factors for atrial fibrillation.
引文
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