长期大量饮酒对心脏功能和结构的影响及相关因素研究

摘要

目的 探讨长期大量饮酒对无症状的男性心脏结构、功能的影响及相关影响因素.方法 横断面入选我国某城乡结合部长期大量饮酒男性,其中单纯饮酒者37例,饮酒合并高血压者19例,按单纯饮酒者与健康对照者2:1原则,纳入年龄匹配的健康对照组18例.超声心动图测定所有入选对象的心脏结构和功能改变,探讨饮酒量及可能导致心脏改变的多种因素的影响.结果 单纯饮酒组平均饮酒时间为(27.8±11.8)年,平均每日酒精摄入量中位数为83.4 g(33.6 g~168.0 g).与健康对照组比较,单纯饮酒组的心肌质量和质量指数均显著升高[(189.18±45.23)g比(142.81±35.24)g,P=0.000;(102.01±25.22)g/m2比(80.03±22.86)g/m2,P=0.003],体质指数、心率、每搏输出量和心指数均显著增加(均为P<0.05).饮酒者心脏形态出现了明显的向心性重构和离心性肥厚.本研究未发现每日酒精摄入量和长期酒精负荷对心肌质量有直接影响,但体质指数升高与心肌质量呈显著正相关[OR=1.29(95%CI:1.028~1.566),P=0.027],尤其在饮酒合并高血压组,体质指数对心肌质量影响更为明显[OR=1.319(95%CI:1.036~1.697),P=0.025].此外,每日酒精摄入量多的人容易出现体质指数增加,ROC曲线显示长期酒精负荷大的人易出现高血压.结论 无症状的长期饮酒者可出现左室重构和心肌质量增加,其原因可能与饮酒引起的超重和高血压有关.%Objective To investigate the impact of long term alcohol abuse on the cardiac structure and function and possible influencing factors in asymptomatic male subjects. Methods This cross-sectional study recruited males from a combination of urban and rural areas of China who drank large amount alcohol,including 37 drinkers without any comorbidity, 19 drinkers with hypertension and 18 normal controls. Cardiac structure and function were evaluated by echocardiography. Multivariate analysis was used to explore the possible influencing factors for the cardiac changes. Results The average duration of drinking in the simple drinking group was(27. 8 ± 11. 8) years,and the median alcohol intake everyday was 83. 4 g (from 33. 6 to 168. 0 g). Compared with the healthy control group,the left ventricular mass(LVM)as well as left ventricular mass index( LVMI) were significantly higher in drinking group [(189. 18 ± 45. 23) g vs. (142. 81 ± 35. 24)g,P = 0. 000;(102. 01 ± 25. 22) g/ m2 vs. (80. 03 ± 22. 86) g/ m2 ,P = 0. 003]. Also the body mass index(BMI),heart rate,cardiac output and cardiac index were increased significantly in drinking group( all P < 0. 05 ) . More than 50% drinker′ s hearts showed significant concentric remodeling and eccentric hypertrophy. We did not find the amount of daily alcohol intake and long-term alcohol burden were associated with LVM,but BMI was positively related to increasing LVM(OR = 1. 29,95% CI:1. 028 - 1. 566, P = 0. 027),especially when drinkers with hypertension(OR = 1. 319,95% CI:1. 036 - 1. 697,P = 0. 025). In addition,the amount of daily alcohol intake was positively associated with increasing BMI,and ROC curves indicated that those with long-term alcohol overload were more likely to develop high blood pressure. Conclusions Long term alcohol abuse can lead to left ventricular remodeling and increased myocardial mass,in asymptomatic subjects, which might be related to alcohol-induced overweight and high blood pressure.