老年高血压合并阻塞性睡眠呼吸暂停综合征对左心室重构的影响

摘要

Objective To observe effects of hypertension with obstructive sleep apnea syndrome(OSAS) on left ventricle remodeling in elderly patients. Methods 56 patients were divided into three subgroups according to monitoring sleep and 24h ambulatory blood pressure,21 patients in the subgroup with hypertension and OSAS, 17 patients in the subgroup of simple hypertension,and 18 patients in the subgroup without both hypertension and OSAS. All patients were examined with Doppler echocardiography. The interventricular septum thickness( IVST) ,the left ventricular posterior wall thickness ( LVPW) and the left ventricular dimension ( LVDd) in end-diastole, left ventricular mass (LVM ) , left ventricular mass index ( LVMI), relative wall thickness ( RWT) , ejection fraction ( EF), left ventricular structure were compared among the subgroups. Results I VST, LVPW, LVM in the subgroup of hypertension with OSAS were greater than those in the subgroup of simple hypertension (P <0. 05) ,and greater than those in the control subgroup(P<0.05). LVDd,LVMI,RWT in the subgroup of hypertension with OSAS were greater than those in the control subgroup(P<0.05). EF in the subgroup hypertension with OSAS was less than that in the control subgroup ( P < 0.05). IVST, LVPW, LVMI, RWT in the subgroup of simple hypertension were greater than those in the control subgroup(P<0.05) ,left ventricular hypertrophy in the subgroup of hypertension with OSAS was thicker than that in the subgroup of simple hypertension ( P < 0. 05 ) , and significantly thicker than that in the control subgroup ( P < 0. 01). There was no patient of left ventricular normal structure in the subgroup of hypertension with OSAS, but 4 patients in the subgroup of simple hypertension,and 9 patients in the control subgroup. The patients with concentric myo-cardial hypertrophy in the subgroup of hypertension with OSAS was more than those in the subgroup of simple hypertension (P< 0.05) ,and in the control subgroup(P<0.01 ). Conclusion Left ventricular hypertrophy occures easily in patients of hypertension with OSAS, which is mainly concentric hypertrophy.%目的 观察老年高血压(HT)合并阻塞性睡眠呼吸暂停综合征(OSAS)对左心室重构的影响.方法 选择56例老年患者,根据睡眠和动态血压监测,分为HT合并OSAS组21例,单纯HT组17例,无HT,也无OSAS为对照组18例,全部对象接受多普勒超声心动图检查.各组间比较舒张末期左心室间隔厚度(VST)、左心室后壁厚度(LVPW)、左心室内径(LVDd),左心室质量(LVM)、左心室质量指数(LVMI)、相对室壁厚度(RWT)、左室射血分数(EF)、左心室结构.结果 HT合并OSAS组的IVST、LVPW、LVM＞单纯HT组(P＜0.05,P＜0.01),＞对照组(P ＜0.05,P＜0.01)；HT合并OSAS组的LVDd、LVMI、RWT＞对照组(P＜0.05,P＜0.01)；HT合并OSAS组的EF＜对照组(P＜0.05)；单纯HT组的IVST、LVPW、LVMI、RWT＞对照组(P＜0.05,P＜0.01)；HT合并OSAS组的左室肥厚＞单纯HT组(P＜0.05)、＞对照组(P＜0.01)；左心室正常构型在HT合并OSAS组为0例、单纯HT组4例、对照组9例；HT合并OSAS组的向心性肥厚例数＞单纯HT组(P＜0.05)、＞对照组(P＜0.01).结论 老年高血压合并OSAS患者更容易发生左心室肥厚,主要为向心性肥厚.