高血压患者左室整体长轴收缩期峰值应变与动态血压的关系

摘要

目的：探讨高血压患者左室整体长轴收缩期峰值应变（GLPS）与动态血压水平及血压变异性（BPV）的关系。方法选取原发性高血压既往未行降压治疗患者79例，以 GLPS 绝对值20％为界分为 GLPS 下降组42例和 GLPS 正常组37例。采用全自动生化分析仪、彩色多普勒超声、动态血压监测仪分别检测两组血清生化指标、心脏功能、左侧肱动脉24 h 血压；采用多元线性逐步回归分析方法明确 GLPS 的独立相关因素。结果两组比较，血清甘油三酯、总胆固醇（TC）、低密度脂蛋白胆固醇水平、心脏舒张末期室间隔厚度、左室重量指数以及全天平均收缩压（24 h SBP）、日间平均收缩压、全天收缩压变异系数、全天舒张压变异系数、夜间舒张压变异系数（nDBPCV）差异均有统计学意义（P ＜0．05或＜0．01）。多元线性逐步回归分析显示，24 h SBP（β＝－0．083，P ＜0．01）、nDBPCV （β＝－8．730，P ＜0．05）、TC（β＝－0．366，P ＜0．05）与 GLPS 独立相关。结论高血压 GLPS 下降患者24 h SBP、nDBPCV 升高，此种变化可引起左室早期收缩功能障碍。%Objective To investigate the relationships between global longitudinal peak systolic strain (GLPS)and mean levels of ambulatory blood pressure and blood pressure variability (BPV)in patients with high blood pressure.Methods A total of 79 untreated hypertensive patients were enrolled into our study.According to the absolute value of GLPS,all patients were di-vided into two groups:normal GLPS group (the absolute value of GLPS≥20%,n =37)and low GLPS group (the absolute value of GLPS <20%,n =42).The biochemical indices of the blood serum,the left ventricular function parameters and 24-hour blood pressure of left brachial artery were collected from the patients by using automatic biochemical analyzer,color Doppler ultrasound and ambulatory blood pressure monitoring,respectively.Determinants of GLPS were identified by multiple linear stepwise regres-sion analysis.Results There were statistically significant differences between the two groups,with respect to triglycerides (TG),total cholesterol (TC),low density lipoprotein cholesterol (LDL-C),interventricular septal thickness at diastole (IVSd),left ventricular mass index (LVMI),24-hour systolic blood pressure (24 h SBP),daytime systolic blood pressure (dSBP),coefficient of variation of 24 hour systolic blood pressure (24hSBPCV),coefficient of variation of 24-hour diastolic blood pressure (24hDBPCV)and coefficient of variation of nighttime diastolic blood pressure (nDBPCV).Multiple linear step-wise regression analysis showed that the 24hSBP (β=-0.083,P <0.01),nDBPCV (β=-8.730,P <0.05)and TC (β=-0.366,P <0.05)were independently associated with GLPS.Conclusion The increase of 24hSBP and nDBPCV is associated with the deterioration of early left ventricular systolic function in hypertensive patients with decreased GLPS.