扩张型心肌病患者收缩压与左心功能的相关性

摘要

目的 探讨扩张型心肌病患者收缩压与左心功能的相关性.方法 选择2004年1月至2015年9月于中国中医科学院广安门医院就诊的扩张型心肌病患者110例,根据入院当天的收缩压水平分为90～109 mmHg(1 mmHg =0.133 kPa)组(38例)、110～129 mmHg组(50例)、130～139 mmHg组(22例),超声心动图检测患者左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心房前后径、右心房左右径、右心室前后径、室间隔厚度(IVST)、左心室后壁厚度、左心室射血分数(LVEF)、左心室短轴缩短率;通过脉冲多普勒模式测量舒张早期二尖瓣血流速度(E)和舒张晚期二尖瓣血流速度(A),计算E/A比值,比较各组一般资料和心功能指标差异,分析各指标与收缩压的相关性.结果 130～139 mmHg组血清肌酐水平明显低于90～109 mmHg组[(81±17) μmol/L比(96 ±20) μmol/L],差异有统计学意义(P＜0.01);各组间其他一般资料比较,差异均无统计学意义(均P＞0.05).110～129 mmHg组及130～139 mmHg组的LVESD及E/A比值明显小于90～109 mmHg组[LVESD:(67±9)、(64 ±8)mm比(72±11)mm,E/A比值:(1.9±0.9)、(1.6±1.0)比(2.7±1.3)],130～139 mmHg组LVEDD明显小于90～109 mmHg组[(77±7)mm比(85±12) mm]、IVST及LVEF明显大于90～109 mmHg组[(9.7±1.6) mm比(8.5 ±1.1)mm、(37±10)％比(31±8)％],差异均有统计学意义(P＜0.05或P＜0.01).各组其他心功能指标比较,差异均无统计学意义(均P＞0.05).扩张型心肌病患者的血清肌酐水平、LVESD、LVEDD、E/A比值与收缩压呈负相关(r=-0.295、-0.312、-0.270、-0.456,P=0.003、0.002、0.009、0.001);IVST、LVEF与收缩压呈正相关(r=0.296、0.261,P=0.003、0.009).结论 扩张型心肌病患者收缩压水平与心功能存在相关性,可以作为评估扩张型心肌病患者心功能情况的辅助指标.%Objective To explore the correlation between systolic blood pressure (SBP) and left verntricular function in patients with dilated cardiomyopathy.Methods One hundred and ten patients with dilated cardiomyopathy from January 2004 to September 2015 were enrolled and divided 90-109 mmHg group (38 cases), 110-129 mmHg group (50 cases) and 130-139 mmHg group (22 cases) according to SBP on the admission day.The indices of echocardiography, including left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVSDD), left atrial dimension, right atrial dimension, right ventricular dimension, interventricular septal thickness (IVST), left ventricular posterior wall thickness, left ventricular ejection fraction (LVEF) and fractional shortening of the ventricular minor semi axis, the mitral valve peak early and late diastolic blood flow velocity (E, A) were measured, and the ratio of E/A was calculated.The general data and cardiac function indices were compared among groups and the correlations between these indices and SBP were analyzed.Results The level of serum creatinine (SCr) in 130-139 mmHg group was significantly lower than that in 90-109 mmHg group [(81 ± 17) μmol/L vs (96 ± 20) μmol/L] (P ＜ 0.01);the other general data were not significantly different among groups (all P ＞ 0.05).The LVESD and E/A in 110-129 mmHg group and 130-139 mmHg group were significantly lower than those in 90-109 mmHg group [(67 ± 9), (64 ± 8) mm vs (72 ± 11) mm, (1.9 ± 0.9), (1.6 ± 1.0) vs (2.7 ± 1.3)] (P ＜ 0.05);the LVEDD was significantly lower, the IVST and LVEF were significantly higher in 130-139 mmHg group than those in 90-109 mmHg group [(77±7) mmvs (85±12) mm, (9.7±1.6) mmvs (8.5±1.1) mm, (37±10)％ vs (31±8)％] (P＜0.05 or P ＜ 0.01).SCr, LVESD and E/A were negative correlated to SBP (r =-0.295,-0.312,-0.270,-0.456, P =0.003, 0.002, 0.009, 0.001), IVST and LVEF were positively correlated to SBP (r =0.296,0.261, P =0.003, 0.009).Conclusions In patients with dilated cardiomyopathy, SBP is related to cardiac function;SBP may be an assistant marker for evaluating cardiac function.