原发性高血压患者颈动脉内-中膜厚度与左室重构的相关性

摘要

Objective: To investigate the relationship between carotid artery intima-media thickness(IMT) and left ventricular remodeling in essential hypertension (EH) patients. Methods: Carotid and cardiac ultrasonography were performed on 78 patients with EH from our hospital and 30 healthy aged persons were selected as normal control. The interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic diameter (LVDd), intima-media thickness in common carotid artery(CCA-IMT) and its bifurcation(BIMT), plaque and hemodynamic parameters in carotid artery were measured respectively, according to corresponding formula to obtain left ventricular mass index (LVMI). According to left ventricular mass index (LVMI), EH patients were divided into left ventricular hypertrophy (LVH) group and non-left ventricular hypertrophy (NLVH) group. Statistical analysis was carried out. Results: The IMT and BIMT were higher in EH group than those in the control group, and LVH group is the highest among the three groups. The prevalence of carotid plaque in EH group was higher than that in control group. Compared with the control group, peak systolic velocity (PSV) of carotid artery was lower in EH group, whereas resistance index(RI) and pulsatility index(PI) were higher. There were positive correlation between LVMI and CCA-IMT, BIMT, RI, PI, and negative correlation between LVMI and PSV. Conclusion: Color Doppler ultrasound is a reliable method to detect the carotid remodeling and left ventricular remodeling in EH patients. The occurrence of carotid remodeling is earlier than that of the left ventricular myocardial remodeling, and there is a close correlation between them.%目的:探讨原发性高血压(EH)患者颈动脉内-中膜厚度(IMT)与左心室重构的关系.方法:筛选本院EH患者78例(EH组),并选取30例健康人为对照组,进行心脏及颈动脉超声检查.分别测量室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张末期内径(LVDd),计算左心室心肌重量指数(LVMI)；测量颈总动脉内-中膜厚度(CCA-IMT)、分叉处内-中膜厚度(BIMT)、斑块以及两侧颈总动脉的血流动力学参数.EH组依据LVMI又分为左心室肥厚(LVH)组和非左心室肥厚(NLVH)组.对所测得的各组数据进行统计分析.结果:EH组CCA-IMT、BIMT高于对照组,其中LVH组最高,颈动脉粥样硬化斑块检出率及严重程度在LVH组最高,NLVH组次之,两者均明显高于正常对照组.EH组颈动脉收缩期峰值流速(PSV)降低,阻力指数(RI)和搏动指数(PI)增高,LVMI与IMT,BIMT,RI和PI成正相关,与PSV成负相关.结论:彩色多普勒超声是检测EH患者颈动脉血管重构与左心室重构的一种可靠方法,颈动脉IMT与左心室重构的发生密切相关,且颈动脉重构的发生早于左心室心肌重构.