高血压患者血同型半胱氨酸与左心室舒张功能和收缩同步性的关系

摘要

目的：探讨H型高血压患者的同型半胱氨酸（ Hcy ）与左心室同步性的关系。方法选取2015年4～12月天津医科大学第二医院诊断为原发性高血压并高 Hcy（Hcy＞15μmol／L）患者79例。按二尖瓣血流频谱舒张早期E峰与二尖瓣环组织频谱舒张早期 e峰比值（E／e）分为 D1组（E／e≤15， n＝39），D2组（E／e＞15，n＝40）。选取同期入院Hcy正常的高血压患者39例作为对照组。测量室间隔厚度（ IVST ）、左心室舒张末期内径（ LVDd ）、左心室收缩末期内径（ LVDs ）、左心室后壁厚度（LVPWT）、左心房内径收缩期前后径（LAD），计算左心室质量指数（LVMI）和射血分数（EF）。测二尖瓣血流频谱E峰与二尖瓣舒张晚期 A 峰比值（ E／A）、E／e，并计算 Tei 指数。三维超声测左心房容积（LAV）并计算左心房容积指数（LAVI）。测量心电图 QRS波起点距左心室16节段达收缩最小容积点时间间隔的标准差心率校正标准化值[ Tmsv16－SD （ R－R％）]。检测血清中 Hcy 浓度及空腹血糖（FBG）。结果 D2组Hcy水平显著高于D1组及对照组[（22．3±4．1）μmol／L比（19．5±2．8）μmol／L、（9．5±3．10）μmol／L，P＜0．05]，D1组Hcy水平高于对照组（P＜0．05）。 D2组 FBG显著高于 D1组及对照组[（6．2±1．6） mmol／L比（5．6±1．1） mmol／L、（5．5±0．9） mmol／L，P＜0．05]，D1组与对照组比较差异无统计学意义（ P ＞0．05）。 D2组 Tmsv16－SD （ R－R％）显著高于 D1组和对照组[（4．07±2．60）％比（1．64±0．85）％、（1．72±1．14）％， P ＜0．05]。 D2组 LAVI 较 D1组、对照组显著增高[（29．7±3．2） mL／m2比（27．3±2．9） mL／m2、（22．1±3．6） mL／m2，P ＜0．05]，D1组 LAVI较对照组明显增高（ P＜0．05）。 D2组 Tei 指数较 D1组和对照组显著增高[（0．56±0．16）比（0．48±0．17）、（0．46±0．08），P ＜0．05]，D1组与对照组比较差异无统计学意义（P ＞0．05）。 Hcy 与 Tmsv16－SD （R－R％）呈正相关（r＝0．289，P＜0．001）。结论 E／e＞15的H型高血压患者左心室收缩同步性下降，且与Hcy浓度呈正相关。 H型高血压患者左心室舒张功能较普通高血压患者更差。%Objective To explore relationship between homocysteine ( Hcy ) and left ventricular dyssyn-chrony in H-type hypertensive patients.Methods Total of 79 patients diagnosed primary hypertension and hyperhomocysteinemia ( Hcy>15 μmol/L ) admitted to the Second Hospital of Tianjin Medical University between Apr.2015 and Dec.2015 were enrolled in the study.According to the ratio of the trans-mitral early peak diastolic velocity ( E) to the early diastolic mitral annulus velocity ( e) ( E/e) ,patients were divided into two groups:D1 group (E/e≤15,n=39) and D2 group (E/e>15,n=40).39 patients with hypertension and normal Hcy during the same period were enrolled as a control group .The interventricular septum thickness (IVST), left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left ventricular posterior wall thickness (LVPWT), left atrial systolic diameter (LAD) were measured by using echocardiography.Left ventricular mass index ( LVMI) and ejection fraction ( EF) were calculated.The E/A ratio, E/e ratio were measured,and the Tei index was calculated.The left atrial volume(LAV) was measured by using three-dimensional echocardiography and left atrial volume index ( LAVI) was calculated.LV dyssyn-chrony was assessed by using three dimensional echo imaging(3DE), represented by Tmsv16-SD(R-R%), meaning the standard deviation of the differences in time intervals to peak systolic volumes in 16 myocardial seg-ments and standardized by R-R interval.Hcy concentration and fasting blood glucose ( FBG) were tested. Results Hcy level in the D2 group was significantly higher than the D1 group and control group [ ( 22.3 ± 4.1) μmol/L vs (19.5 ±2.8) μmol/L ,(9.5 ±3.1) μmol/L, P<0.05], Hcy level in the D1 group was significantly higher than the control group ( P<0.05 ) .FBG in the D2 group was significantly higher than the D1 group and control group [ ( 6.2 ±1.6 ) mmol/L vs ( 5.6 ±1.1 ) mmol/L, ( 5.5 ±0.9 ) mmol/L, P <0.05].No significant difference was found between D1 group and control group.Tmsv16-SD(R-R %) in the D2 group was significantly higher than the D1 group and control group [(4.07 ±2.6)%vs (1.64 ±0.85)%, (1.72 ±1.14)%, P<0.05].LAVI in the D2 group was significantly higher than the D1 group and control group [(29.7 ±3.2) mL/m2 vs (27.3 ±2.9) mL/m2,(22.1 ±3.6) mL/m2, P<0.05], LAVI in the D1 group was significantly higher than the control group(P<0.05).Tei index in the D2 group was significantly higher than the D1 group and control group [ ( 0.56 ±0.16 ) vs ( 0.48 ± 0.17 ) , ( 0.46 ±0.08 ) , P <0.05], while there was no significantly difference between the D1 group and control group (P>0.05).Hcy was positively correlated with Tmsv16-SD(R-R%) (r=0.289, P<0.001).Conclusion Patients with E/e ratio >15 in H-type hypertension have left ventricular dyssynchrony, which is positively associated with Hcy concentration.Diastolic dysfunction of patients with H-type hypertension is worse than patients with normal type hypertension.