原发性高血压伴左心室肥厚患者的升主动脉弹性

摘要

目的:探讨原发性高血压伴左心室肥厚(LVH)患者的升主动脉弹性特征.方法:192例诊断为原发性高血压患者采用128层双源CT行冠状动脉CT成像.将原始数据每间隔5％RR间期进行全时相重建.以垂直于左冠状动脉主干发出主动脉根部层面为参考平面,取其上25 mm作为升主动脉兴趣层面.采用三个较常见的指标可扩张度(AD)、动脉顺应性(AC)、动脉僵硬度(ASI)评价升主动脉弹性.结果:原发性高血压伴LVH组52例(26.6％),不伴LVH组140例(73.4％).伴LVH组和不伴LVH组间高血压病程和24h平均收缩压及脉压有统计学差异.伴LVH组的升主动脉AD[(1.71±0.96)×10 3mmHg 1 vs(3.14±1.21)×10-3 mmHg-1]和AC[(1.03±0.49)mm2mmHg-1 vs (1.72±0.79)mm2mmHg-1]较不伴LVH组显著降低,而ASI(11.07±6.6 vs21.39±15.22)显著增加(P均＜0.001);俩组间升主动脉标化舒张期最小直径无统计学差异,最小面积和肱踝脉波传导速度(baPWV)有统计学差异(P＜0.05).结论:高血压合并LVH患者的升主动脉弹性较无LVH者明显减退,其程度强于传统baPWV和形态学.在不增加医疗成本前提下,利用冠状动脉CT成像获得升主动脉弹性指标,对早期识别高血压LVH有一定的临床意义.%Objective:To investigate the characteristics of the elasticity of ascending aorta in patients with primary hy pertension in combination with left ventricular hypertrophy (LVH).Methods:192 patients had the diagnosis of primary hypertension underwent coronary CT angiography (CTA) examination using a 128 slice CT scanner,the raw data were automatically reconstructed at every 5 ％ RR interval in the entire phase.Taking the plane which is vertical to that as left coronary trunk originated from the root of aorta as reference,and 25mm above as the plane of interest of ascending aorta.Aortic distensibility (AD),aortic compliance (AC) and aortic stiffness (ASI) were taken as the indices to evaluate the aortic elasticity,analysis was performed.Results:There were 52 patients (26.6％) had primary hypertension in combination with LVH,and 140 patients (73.4％) without LVH.The course of hypertension in the groups with and without LVH showed significant statistic differences in the 24h mean systolic pressure and 24h mean pulse pressure.In the group with LVH compared with that without LVH,the ascending aortic AD was [(1.71±0.96) × 10 3mmHg-1 vs (3.14± 1.21) × 10 3mm Hg-1] and AC was [(1.03±0.49)mm2mmHg 1 vs (1.72±0.79)mm2mmHg-1],which were found much lower in LVH group compared with that of non-LVH group (P＜0.001).While the ASI (21.39±15.22 vs 11.07 ± 6.6) was significantly increased (P＜0.001).The minimum cross section diameter was not significantly different between the two groups,while the brachial ankle PWV (baPWV) and the minimum cross section area was found to have statistic difference (P＜0.05).Conclusions:Significant declination of ascending aortic elasticity can be found in primary hypertension patients with LVH,the degree is more obvious compared with that of conventional baPWV method and ascending aortic morphology.Ascending aortic elasticity derived from coronary CTA may provide early detection of primary hypertension with LVH in clinical practice without additional medical consumption.