超声技术综合评价H型高血压患者左室舒张功能的初步研究

发布时间：2018-06-22 04:16

本文选题：高血压 + 血同型半胱氨酸　；参考：《天津医科大学》2015年硕士论文

【摘要】：目的:应用超声心动图技术综合评价H型高血压患者的左室舒张功能,并对其可能的临床价值进行初步探讨。方法:选取2014年4月至2015年2月天津医科大学第二医院住院且确诊为原发性高血压的患者159例,依据血同型半胱氨酸(HCY)水平将其分为HCY10μmol/L组即非H高血压组(A组)54例和HCY≥10μmol/L组即H型高血压组(B组)105例。另选取24例血压正常、心电图及胸片等常规检查无异常者作为对照组(N组)。应用Philips iE33型彩色心脏超声诊断仪,配有QLAB 3DQ Advanced定量分析软件程序,X5-1探头,探头频率1.0-5.0MHz。二维超声检测室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室舒张末内径(LVDd)、左室收缩末内径(LVDs)、左房内径(LAD),Simpson法检测左室射血分数(LVEF)。脉冲多普勒检测二尖瓣血流频谱舒张早期E峰峰值、舒张晚期A峰峰值及E峰减速时间(DT),并计算E/A,获取右上肺静脉收缩期峰值流速(PVS)、舒张早期峰值流速(PVD)、舒张晚期峰值流速(PVA),并计算S/D。组织多普勒(TDI)检测二尖瓣环频谱舒张早期Em峰峰值、舒张晚期Am峰峰值及等容舒张时间(IRT),计算E/Em、Em/Am,并根据公式Tei=a-b/a计算Tei指数。彩色M型超声(CMD)检测左室内血流传播速度(Vp)。实时三维全容积法测量左房容积(LAV),并根据公式LAVI=LAV/BSA计算左房容积指数(LAVI)。所有入选患者记录身高、体重、吸烟史、饮酒史、计算体表面积(BSA);测量血压、血糖、血脂及血HCY等指标。结果:1.B组HCY明显高于N组及A组(P0.05),A、B组收缩压及甘油三酯明显高于N组(P0.05),A组TC高于N组及B组(P0.05),余组间一般资料及生化指标未见统计学差异(P0.05)。2.三组常规超声结构测值LAD、LVDs、LVDd、IVST、LVPWT及收缩功能指标LVEF无统计学差异(P0.05)。3.与n组相比,a组与b组em/am及e/a明显减低,e/em明显增高(p0.05);与a组相比,b组em/am更低而e/em更高(p0.05);a、b组间e/a无显著差别(p0.05)。b组irt明显高于n组而s/d明显低于n组(p0.05),a、n组间未见显著差别(p0.05)。dt在三组间未见显著差异(p0.05)。4.a组、b组tei指数及lavi较n组明显增高(p0.05),且b组tei指数及lavi明显高于a组(p0.05)。a组、b组vp较n组明显减低(p0.05),且b组vp明显低于a组(p0.05)。5.a、b组tei指数与em/am呈显著负相关(p0.05);与e/em呈显著正相关(p0.05);与e/a未见相关关系(p0.05)。6.a、b组患者vp与e/em呈显著负相关(p0.05);与em/am呈显著正相关(p0.05),与e/a未见相关关系(p0.05)。7.a、b组lavi与e/em呈显著正相关(p0.05);与em/am及e/a呈显著负相关(p0.05)。8.tei指数与vp呈负相关(r=-0.432,p0.01)、与lavi呈正相关(r=0.336,p0.05);vp与lavi呈负相关(r=-0.300,p0.05)。9.a、b组hcy与em/am、vp呈负相关(p0.05);与收缩压、e/em、lavi及tei指数呈正相关(p0.05),其中与e/em、lavi、vp及tei指数的相关系数较高,分别为0.839、0.666、-0.548及0.519;hcy与高血压病程、年龄、舒张压水平、lvef、e/a无明显相关(p0.05)。结论:1.高血压患者左室舒张功能改变较心脏结构及收缩功能改变出现更早且明显。2.h型高血压患者左室舒张功能障碍更为明显,且hhcy与多项舒张功能指标显著相关,提示舒张功能改变可能与hhcy有一定关系。3.左房容积指数更能确切反映左房大小,可作为较左房内径更佳的左房结构指标。4.tei指数、vp及lavi与传统的超声指标存在良好相关,且在检测舒张功能时不存在假性正常化,可更广泛的应用于临床评价左室舒张功能。5.积极治疗h型高血压,可否延缓高血压患者左室舒张功能障碍的发生及进展尚需进一步研究。
[Abstract]:Objective: To evaluate the left ventricular diastolic function of patients with type H hypertension by echocardiography, and to discuss its possible clinical value. Methods: 159 patients hospitalized in Second Hospital Affiliated to Tianjin Medical University from April 2014 to February 2015 were diagnosed as essential hypertension, and the level of blood homocysteine (HCY) was based on the level of blood homocysteine (HCY). It was divided into group HCY10 mu mol/L, that is, 54 cases of non H hypertension group (group A) and 105 cases of H type hypertension group (group B) with HCY more than 10 mu mol/L group (B group). Besides, 24 cases of normal blood pressure, electrocardiogram and chest X-ray examination were selected as control group (N group). The Philips iE33 color echocardiography was used. 5-1 probes, probe frequency 1.0-5.0MHz. two-dimensional ultrasound examination interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic diameter (LVDd), left ventricular end systolic diameter (LVDs), left atrium diameter (LAD), Simpson method to detect left ventricular ejection fraction (LVEF). Pulse Doppler detection of the early diastolic peak peak of diastolic peak, late diastolic A peak peak Value and E peak deceleration time (DT), and calculate E/A, obtain the peak systolic peak velocity (PVS), early diastolic peak velocity (PVD), late diastolic peak velocity (PVA), and calculate the peak value of the early diastolic peak, the peak value of the late diastolic Am peak and the equal volume diastolic time (IRT) of the S/D. tissue Doppler (TDI), and calculate the E/Em. The Tei index was calculated by the formula Tei=a-b/a. The left chamber flow velocity (Vp) was measured by color M ultrasound (CMD). The left atrial volume (LAV) was measured in real time three-dimensional full volume method (LAV), and the left chamber volume index (LAVI) was calculated according to formula LAVI=LAV/BSA. All selected patients recorded height, weight, smoking history, drinking history, and calculated body surface area (BSA), and measured blood pressure, Results: the HCY in group 1.B was significantly higher than that of group N and A group (P0.05). The systolic pressure and triglyceride in group of A and B were significantly higher than that of group N (P0.05), and A group TC was higher than that of group N (P0.05), and there was no statistical difference between the general and biochemical indexes of the remaining three groups. Compared with group n, em/am and e/a in a group and B group were significantly lower and e/em significantly increased (P0.05) than that of group n (P0.05). There was no significant difference between group A and a group (P0.05) in a group and B group (P0.05). There was no significant difference (P0.05) in group.4.a, and the Tei index and Lavi in group B were significantly higher than those in N group (P0.05), and the Tei index and Lavi of B group were significantly higher than those of a group (P0.05). There was a significant negative correlation between VP and e/em (P0.05) in group B (P0.05); there was a significant positive correlation with em/am (P0.05), and no correlation with e/a (P0.05).7.a, and there was a significant positive correlation between the B group and the e/a (P0.05). VP and Lavi were negatively correlated (r=-0.300, P0.05).9.a, B group Hcy and em/am, VP showed negative correlation (P0.05), and had a positive correlation with systolic pressure, e/em, Lavi, and index index. 5) conclusion: 1. the changes of left ventricular diastolic function in patients with hypertension were earlier than those of cardiac structure and systolic function, and left ventricular diastolic dysfunction in patients with type.2.h hypertension was more obvious, and HHcy was significantly related to multiple diastolic function indicators, suggesting that the diastolic function may be more accurate in relation to the.3. left atrial volume index (HHcy). The size of the left atrium can be used as an index of the left atrial structure that is better than that of the left atrium. VP and Lavi have a good correlation with the traditional ultrasound indicators, and there is no pseudonormalization in the detection of diastolic function. It is more widely used in the clinical evaluation of the left ventricular diastolic function of.5. accumulation in the treatment of H type hypertension, and may delay the hypertension patients. The occurrence and progress of left ventricular diastolic dysfunction need further study.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R544.1

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