摘要
目的探讨老年原发性高血压(EH)合并舒张性心力衰竭(DHF)患者的临床特点。方法选择老年EH患者104例(男75例,女29例),根据是否存在DHF分为EH组(n=52)和EH合并DHF组(EH+DHF组,n=52)。收集2组患者一般资料,并采用动态血压监测仪进行24 h动态血压监测并收集监测指标,包括24 h、白天、夜间平均收缩压(24 h SBP,d SBP,n SBP)及收缩压负荷(24 h SBPL,d SBPL,n SBPL),24 h、白天、夜间平均舒张压(24 h DBP,d DBP,n DBP),计算夜间血压下降率(NBPDR)。行超声心动图检查测定左心室舒张功能指标:左心房内径(LAD)、二尖瓣舒张早期(E)及舒张晚期血流峰速(A),E峰减速时间(EDT)、左心室射血分数(LVEF)。用心肌组织多普勒成像测量二尖瓣环舒张早期运动峰速(Em),计算E/Em值。测量左心室舒张末期内径(LVEDd)、室间隔厚度(IVSd)、左心室后壁厚度(LVPWd),并计算左心室质量(LVM)、质量指数(LVMI)和相对室壁厚度(RWT)。结果 EH+DHF组患者较EH组年龄大(P<0.05)。EH+DHF组患者糖尿病、冠心病、房颤的发生率较EH组显著升高(P<0.01,P<0.01,P<0.05)。与EH组相比,EH+DEF组患者n SBP、24 h SBPL及n SBPL显著增高(P<0.05,P<0.05,P<0.01);而d DBP显著降低(P<0.05)。与EH组相比,EH+DHF组患者LAD与E/Em值显著增加(P<0.001,P<0.01),LVEDd、LVSd、及LVPWd也显著增加(P均<0.05)。且2组患者LVMI、RWT及RWT≥0.44患者的比例均存在统计学差异(P均<0.05)。结论老年EH合并DHF较多见于高龄患者,且多伴发糖尿病、冠心病及房颤;其n SBP及收缩压负荷显著增高,d DBP显著降低,血压昼夜节律异常较多见;且左心室重构程度及发生的比率显著增加。
Objective To investigate the clinical characteristics in the elderly patients with combined hypertension and diastolic heart failure.Methods A total of 104 elderly patients with hypertension（75 male,29 female）were recruited for the study. These patients were divided into two groups according to whether complicated with diastolic heart failure or not（EH group and EH＋DHF group）. 24 h SBP,dSBP,nSBP and 24 hSBPL,dSBPL,nSBPL and 24 hDBP,dDBP,nDBP were measured by ABPM. LAD,E and A waves,EDT,Em LVEDd,IVSd,LVPWd,LVEF,were measured by echocardiography and tissue Doppler imaging. E/Em,LVM,LVMI,RWT were calculated. Results The patients in EH＋DHF group were older than the EH group（P〈0.05）. There were higher incidence of diabetes,CHD and AF in EH＋DHF group（P〈0.05）. There were also higher nSBP,24 hSBPL,nSBPL and lower dDBP in EH＋DHF group（P〈0.05）. The number of patients with NBPDR was greater in EH＋DHF group than in EH group（P〈 0.01）. In EH＋DEF group,LAD and E/Em were significantly higher than EH group（P 〈0.01）. LVMI and RWT were also significantly higher than EH group（P〈0.05）. Patients with LV remodeling in EH＋DEF group were more than EH group. Conclusion Senile primary hypertension with diastolic heart failure is more common in elderly patients,and most of them are associated with diabetes,coronary heart disease and atrial fibrillation. Among these patients with combined hypertension and diastolic heart failure,the average night systolic blood pressure and systolic blood pressure load were increased,average diastolic blood pressure was significantly reduced during the day,and the abnormal blood pressure circadian rhythm was more commonly observed;in addition,the degree of left ventricular remodeling was increased and the ratio of LV remodeling was also significantly increased.
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2015年第9期803-805,809,共4页
Journal of China Medical University
基金
辽宁省教育厅科研项目计划(L2010593)
关键词
心力衰竭
舒张性
原发性高血压
动态血压监测
经胸多普勒超声心动图
左心室重构
老年
heart failure
diastolic
essential hypertension
ambulatory blood pressure monitoring
transthoracic Doppler-echocardiog- raphy
left ventricular remoderling
elderly
