【作者】 张硕；

【导师】 张赛丹；

【作者基本信息】 中南大学 ， 临床医学， 2013， 博士

【摘要】 目的：采用超声心动图指标(E/A、Em、Em/Am、LADI及LAVI)评估高血压治疗后左室舒张功能改善程度及获益时间。探讨左室舒张功能改善与降压药物选择及与降压疗效之间的关系。方法：121例原发性高血压患者,51例健康志愿者,行超声心动图检查：获取左房内径(LAd)、左房容积(LAV)、舒张早期和晚期二尖瓣血流峰速度(E,A)、组织多普勒(PW-TDI)舒张早期和舒张晚期二尖瓣环运动峰速度(Em, Am),计算LADI、LAVI、E/A以及Em/Am左室舒张功能指标。将121例高血压患者随机分为两组：A组服用左旋氨氯地平+厄贝沙坦；B组服用左旋氨氯地平+阿罗洛尔。于治疗前、治疗后四周及八周测量血压及上述超声心动图指标。结果：1、与正常组(N组)相比,高血压组(A组+13组)LADI、 LAVI以及LVMI显著高于对照组,E/A、Em/Am、Em显著低于对照组,差异具有统计学意义(P<0.05)。2、治疗四周及八周,A组及B组与治疗前比较,超声指标Em/Am、Em显著升高,差异具有统计学意义(P<0.05)。3、治疗四周,与治疗前比较,A、B两组超声指标LAVI无显著变化(P>0.05)；治疗八周,与治疗前比较,两组LAVI均显著降低(P<0.05)。且B组LAVI显著低于A组(P<0.05)。4、分别以各舒张功能指标的变化幅度LAVIC、Em/Amc、Emc为应变量,以SBPC、DBPC、MAPC、PPC、用药时间长短(治疗四周赋值1,治疗八周赋值2)、降压药物选择(A组方案赋值1,B组方案赋值2)为自变量,作多元逐步线性回归分析,得出多元线性回归方程如下：LAVIC=-3.596X用药时间长短+0.037XPPc+3.582(F=18.774, P<0.05); Em/AmC=-0.006XPPc+0.138X用药时间长短+0.076X降压药物方案-0.139(F=21.170,P<0.05); EmC=-0.026XPPc+0.726X用药时间长短+0.104(F=6.630,P<0.05)。结论：1、降压治疗四周,即能在超声心动图下能检测到左室舒张功能改善。2、Em、Em/Am较LAVI更早更敏感地反映降压后左室舒张功能的逆转。3、降压治疗后,阿罗洛尔较厄贝沙坦,更早地显现出对左室舒张功能指标LAVI的逆转作用。4、治疗后脉压下降幅度、用药时间长短及降压药物方案是超声下左室舒张功能指标LAVI、Em及Em/Am改善的独立影响因素。更多还原

【Abstract】 Objective:We aimed to explore whether the hypertensives benefits from anti-hypertension therapy in left ventricular diastolic function by Echocardiography and the relationship between the improvement of left ventricular diastolic function and medication of anti-hypertensive drugs.Methods:121patients with essential hypertension and51healthy controls were enrolled in this study. All of them were detected by conventional echocardiography for left atrial diameter(LAd), left atrial volume(LAV), the early and late diastolic peak velocity of mitral inflow (E,A), and the early and late diastolic peak velocity of mitral annulus myocardium(Em,Am) in PW-TDI. The parameters of LADI, LAVI, E/A, and Em/Am were calculated. The eligible patients were randomly assigned to group A or group B. Group A was treated with Levoamlodipine and Irbesartan. Group B was treated with Levoamlodipine and Arottnolol. The blood pressure and Echocardiographic examination were detected at baseline(0-week treatment),4-weeks and8-weeks treatment. Result:1. Compared to the control group(group N), LADI,LAVI and LVMI raised, while E/A, Em and Em/Am decreased in the hypertensive group(group A+B). The difference between the groups was significant (P<0.05).2. Compared to the baseline, Em/Am and Em increased in group A and group B, after4-weeks and8-weeks treatment (P<0.05).3. LAVI had no change in group A and group B after4-weeks treatment (P>0.05). After8-weeks treatment,compared to the baseline, LAVI decreased in group B and group A(P<0.05). Compared to group A,LAVI decreased in group B after8-weeks treatment(P<0.05).4. The stepwise regression analysis were showed:LAVIC=-3.596Xthe period of treatment+0.037XPPc+3.582(F=18.774, P<0.05).Em/AmC:=-0.006XPPc+0.138Xthe period of treatment+0.076Xtherapeutic regimen-0.139(F=21.170, P<0.05).EmC=-0.026XPPc+0.726Xthe period of treatment+0.104(F=6.630, P<0.05).Conclusion:1.Both Levoamlodipine combined with Irbesartan and Levoamlodipine combined with Arottnolol could improve the diastolic function of left ventricle after4-weeks treatment.2.Compared to LAVI, Em and Em/Am were more sensitive to reflect the improvement of left ventricular diastolic function after anti-hypertension therapy.3.Compared with Irbesartan, Arottnolol may be more effective on the earlier improvement of LAVI in left ventricular diastolic function.4.The change of PP, the period of treatment and therapeutic regimen were important independent impact factors of the improvement of LAVI, Em and Em/Am in left ventricular diastolic function.更多还原