中青年难治性高血压患者心室-动脉耦联的初步探讨-现代医学

中青年难治性高血压患者心室-动脉耦联的初步探讨

作者：杜天天¹ 2 庞敏³ 蔡情情⁴ 杨波⁴ 厉志洪³ 李春梅¹ 5 王雷¹ 5 宫海滨¹ 5

单位：1. 徐州市心血管病研究所, 江苏徐州 221009;
2. 徐州市中心医院急诊科, 江苏徐州 221009;
3. 徐州市中心医院超声科, 江苏徐州 221009;
4. 徐州医科大学研究生学院, 江苏徐州 221009;
5. 徐州市中心医院心内科, 江苏徐州 221009

关键词：难治性高血压中青年心室功能动脉僵硬度心室-动脉耦联

分类号：R544.1

出版年·卷·期（页码）：2017·36·第五期（634-637）

摘要：

目的：初步探讨中青年难治性高血压（RH）患者的心脏、血管弹性的变化。方法：选择中青年（18～65岁） RH患者、可控性高血压（CH）患者和血压正常（NT）者各50例，分别检测中心动脉压、颈股脉搏波传导速度（cfPWV）、增强指数（AIx@75%）、左室结构、左室舒张功能（E/e）和血流动力学等参数，计算心室-动脉耦联等指标。结果：cfPWV值RH组高于CH组及NT组（均P < 0.05），CH组高于NT组（P < 0.05）。有效动脉弹回（Ea）、左室收缩末弹回（Ees）、左室舒张末弹回（Eed）值RH组高于CH及NT组（均P < 0.05）。多因素线性回归分析显示，在总体人群中AIx@75%是心室-动脉耦联指数的独立危险因素。结论：中青年RH患者的心室及动脉僵硬增加，心室-动脉匹配关系发生了变化。

Objective: To evaluate the change of heart and vascular elasticity in young and middle-aged patients with resistant hypertension(RH).Methods: Fifty young and middle-aged patients (18-65 years old) with RH, 50 patients with controlled hypertension (CH) and 50 patients with normotensives (NT) were enrolled in this study. All subjects were performed examinations including center arterial pressure,carotid femoral artery pulse wave velocity (cfPWV),augmentation index (AIx@75%),structure and diastolic function (E/e) of left ventricular and hemodynamic parameters.Then the heart and artery elasticity as well as corresponding parameters were calculated.Results: cfPWV inRH group increased faster than CH group and NT group (all P<0.05) and CH patients was also faster than NT group (P<0.05).Effective arterial elastance(Ea),end systolic ventricular elastance (Ees),end diastolic ventricular elastance(Eed) of RH group were higher than those of CH group and NT group (all P<0.05).Multi-factor linear regression analysis showed that AIx@75% was the independent risk factor for ventricular-arterial coupling index(VACI) in the general population. Conclusions: The ventricle and arterial stiffness in young and middle-aged patients with RH are more severe,and their matching relationship also changes.

参考文献：

[1] SHIM C Y.Arterial-cardiac interaction:the concept and implications[J].J Cardiovasc Ultrasound,2011,19(2):62-66.
[2] SAFARM E,O'ROURKE M F,FROHLICH E D.Blood pressure and arterial wall mechanics in cardiovascular diseases[M].London:Springer-Verlag,2014:15-21.
[3] DAVID A,CALHOUN M D.难治性和顽固性高血压:降压治疗抵抗和治疗失败[J].中华高血压杂志,2015(7):612-615.
[4] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2010,18(1):11-30.
[5] van BORTEL L M,LAURENT S,BOUTOUYRIE P,et al.Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity.[J].J Hypertensions,2012,30(3):445-448.
[6] CHANTLER P D,LAKATTA E G,NAJJAR S S.Arterial-ventricular coupling:mechanistic insights into cardiovascular performance at rest and during exercise[J].J Appl Physiol,2008,105(4):1342-1351.
[7] HA J W,LEE H C,PARK S,et al.Gender-related difference in left ventricular diastolic elastance during exercise in patients with diabetes mellitus.[J].Circ J,2008,72(9):1443-1448.
[8] BORLAUG B A,REDFIELD M M,MELENOVSKY V,et al.Longitudinal changes in leftventricular stiffness:a community-based study[J].Circ Heart Fail,2013,6(5):944-952.
[9] VAARTIES S R,BOOM H B.Left ventricular internal resistance and unloaded ejection flow assessed from pressure-flow relations:a flow-clamp study on isolated rabbit hearts[J].Circ Res,1987,60(5):727-737.
[10] YRIH D F,LIN L Y,YEH H I,et al.Temporal changes in cardiac force-and flow-generation capacity,loading conditions,and mechanical efficiency in streptozotocin-induced diabetic rats[J].Am J Physiol Heart Circ Physiol,2008,294(2):H867-874.
[11] 杜天天,郑成,蔡情情,等.中青年难治性高血压患者血清同型半胱氨酸与动脉僵硬度的关系[J].中华高血压杂志,2016(6):547-551.
[12] MATHIEU M,OUMEIRI B E,TOUIHRI K,et al.Ventricular-arterial uncoupling in heart failure with preserved ejection fraction after myocardial infarction in dogs-invasive versus echocardiographic evaluation[J].BMC Cardiovascular Disorders,2010,10(1):32.
[13] van den HURK K,ALSSEMA M,KAMP O,et al.Independent associations of glucose status and arterial stiffness with left ventricular diastolic dysfunction an 8-year follow-up of the hoorn study[J].Diabetes Care,2012,35(6):1258-1264.
[14] MOTTRAM P M,HALUSKA B A,LEANO R,et al.Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease[J].Heart,2005,91(12):1551-1556.
[15] SAMSON R,JAISWAL A,ENNEZAT P V,et al.Clinical phenotypes in heart failure with preserved ejection fraction[J].J Am Heart Assoc,2016,5(1):2103-2116.

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