原发性高血压患者心腔内血流和左室构型及舒张功能关系的初步研究
发布时间：2018-07-14 12:35
【摘要】：背景原发性高血压是一种临床常见疾病,以体循环动脉压的增高为主要特点,可引起靶器官结构和功能异常,如心、脑、肾等脏器的正常结构功能损害。心室后负荷增加,可造成心腔内血流流动规律改变,心腔内正常流场紊乱。有研究表明,高血压性心脏病是造成射血分数保留心衰的重要因素之一,早期准确评价左室功能改变具有重要意义,但心腔内血流改变与舒张功能减退和心室重构的关系尚需进一步明确。血流向量成像技术(VFM)可对心腔内血流动力学改变进行定量评价,计算心腔血流流动过程中摩擦产生的能量损耗和涡流循环量等指标。既往研究对于高血压进行左室构型分析多采用符合欧美人群标准的Ganau分型,而针对中国高血压人群构型特点的血流动力学研究尚未见报导,有待进一步研究。目的1、比较中国标准和国际标准下高血压构型分布特点,观察不同标准下左心功能和血流动力学表现是否存在差异。2、根据中国人群超声正常值对高血压患者进行构型分析,评估高血压患者舒张期左室内能量损耗及涡流循环量等血流变化特点。3、探讨左心室血流动力学变化与舒张功能的关系,分析血流向量成像技术在评价高血压患者左室舒张功能中的应用价值。研究对象高血压组:根据中国高血压防治指南2010诊断标准,在不同日进行3次血压测量,若未服用过降压药,收缩压≥140mmHg(lmmHg=0.133kPa)和(或)舒张压≥90mmHg,即诊断为高血压;若血压低于140/90mmHg,但既往有高血压病病史,并正在使用降压药物,也诊断为高血压。排除伴有冠心病、糖尿病、心力衰竭、高脂血症、心包积液、肺气肿、心律失常、脑卒中、心肌梗死、瓣膜病、甲状腺疾病、先天性心脏病、贫血、心肌病、结缔组织疾病、妊娠或哺乳期妇女、心电图检查异常、恶性肿瘤及其他系统严重疾病的患者,共63名高血压患者。对照组:共23名健康志愿者,与高血压组的年龄、性别相匹配。方法1、基本信息采集:包括受检者的姓名、性别、年龄、身高、体重、血压、心率、烟酒史、血脂、血糖、病史等基本信息。2、超声图像采集:(1)采用日本Hitachi公司Aloka Prosound F75型彩色多普勒超声诊断仪,受检者取左侧卧位,连接肢体导联,同步记录心电图,采集胸骨旁左室长轴切面、心尖二腔心切面、心尖四腔心切面动态图像,留取连续三个心动周期,测量左室收缩末期左房内径(LAD)、主动脉内径(AO)、左室舒张末内径(LVID)、左室后壁(LPW)及室间隔厚度(IVS),计算相对室壁厚度(RWT)、左室质量(LVM)、左室质量指数(LVMI)及左室射血分数(LVEF)。用双平面Simpson法测量左房容积(LAV),计算左房容积指数(LAVI)。(2)测量二尖瓣舒张早期E波血流速度(E)、二尖瓣舒张晚期A波血流速度(A)、二尖瓣舒张早期血流减速时间(DT),计算E/A。测量三尖瓣反流速度(TRV)。(3)测量舒张早期二尖瓣环室间隔、侧壁心肌运动峰值速度,分别为e'(s)、e'(1),计算平均值e'和E/e'。3、血流向量成像测量:启用VFM模式,采集心尖三腔心切面动态图像,留取连续三个心动周期,导入工作站进行脱机分析。参考图像标尺,将左室划分为心尖段、中间段、基底段三个节段;结合时间-流量曲线和主动脉瓣、二尖瓣开闭情况,确定等容舒张期、快速充盈期、缓慢充盈期和心房收缩期,测量不同时期左室整体及各节段平均能量损耗,各时期涡流循环量及涡流面积。4、应用SPSS23.0软件进行统计分析结果1、基本资料比较(1)依照中国标准进行高血压构型分析,得到NG组27例(43%),CR组5例(8%),EH组21例(33%),CH组10例(16%)。依照国际标准进行高血压构型分析,得到 NG 组 17 例(27%),CR 组 23 例(36%),EH 组 6 例(10%),CH 组 17例(27%),与中国人群构型分析结果存在统计学差异(p0.05)。(2)高血压组与对照组间心率无统计学差异(p0.05)。与对照组相比,高血压组及各亚组收缩压、舒张压均增大(p0.05);各亚组间收缩压、舒张压无统计学差异(p0.05)。2、根据中国标准超声检查常用指标比较(1)左室室壁厚度:高血压组LPW、IVS、RWT较对照组增大,差异有统计学意义(p0.05)。(2)心腔内径:高血压组LAD、AO较对照组增大,差异有统计学意义(p0.05)。高血压组与对照组间LVID无统计学差异(p0.05)。(3)左室质量:高血压组LVM、LVMI较对照组增大,差异有统计学意义(p0.05)。(4)左房容积:高血压组LAV、LAVI较对照组增大(p0.05);EH组和CH组左房容积较NG组增大,差异有统计学意义(p0.05)。(5)左室射血分数:高血压组与对照组间LVEF无统计学差异(p0.05)。(6)舒张期二尖瓣口血流速度:高血压组与对照组间E、DT无统计学差异(p0.05)。与对照组相比,高血压组E/A减小(p0.05),NG组、EH组E/A减小(p0.05)。与对照组相比,高血压组及各亚组A均增加(p0.05)。(7)舒张期二尖瓣环心肌运动速度:与对照组相比,高血压组及各亚组e'(s)、e'(1)均减低(p0.05);EH组e'(s)、e'(1)较NG组增大(p0.05)。与对照组相比,高血压及各亚组E/e'均增加(p0.05)。(8)三尖瓣血流反流速度:与对照组相比,高血压组及各亚组间TRV均无统计学差异(p0.05)。3、根据中国标准能量损耗比较(1)等容舒张期:与对照组相比,高血压组左室整体、基底段、中间段及心尖段平均能量损耗无统计学差异(p0.05)。(2)快速充盈期、缓慢充盈期:与对照组相比,高血压组左室整体、基底段、中间段及心尖段平均能量损耗无统计学差异(p0.05)。(3)心房收缩期:与对照组相比,高血压组左室整体、基底段、中间段平均能量损耗增大(p0.05);心尖段平均能量损耗与对照组相比无统计学差异(p0.05)。与对照组相比,高血压NG组中间段能量损耗增大(p0.05),EH组基底段、中间段能量损耗增大(p0.05);CH组中间段能量损耗较NG组、EH组减小,差异有统计学意义(p0.05)。4、根据中国标准涡流比较(1)等容舒张期:高血压组与对照组均无显著涡流出现。(2)快速充盈期:与对照组相比,高血压组二尖瓣前、后叶的涡流循环量和涡流面积无统计学差异(p0.05);各亚组间无统计学差异(p0.05)。(3)缓慢充盈期:与对照组相比,高血压组涡流循环量、涡流面积无统计学差异(p0.05);各亚组间无统计学差异(p0.05)。(4)心房收缩期:与对照组相比,高血压组二尖瓣后叶的涡流循环量和涡流面积增大(p0.05),NG组、EH组二尖瓣后叶的涡流循环量和涡流面积增大(p0.05)。高血压组二尖瓣前叶的涡流循环量和涡流面积较对照组无统计学差异(p0.05)。5、构型分析(1)对中国标准、国际标准结果进行分析,在不同标准下对NG组、CH组进行比较,心功能指标 LAVI、E、A、E/A、TRV、e'(s)、e'(1)、E/e'、LVEF 无统计学差异(p0.05)。中国标准与国际标准分组间左室整体及各节段平均能量损耗、左室涡流循环、涡流面积无统计学差异(p0.05)。(2)依照国际标准对能量损耗进行高血压亚组分析,各亚组间及与对照组间左室整体及各节段平均能量损耗无统计学差异(p0.05)。(3)依照国际标准对涡流进行高血压亚组分析,心房收缩期NG组、CR组二尖瓣后叶的涡流循环量和涡流面积较对照组增大(p0.05)。6、相关性分析(1)对高血压组能量损耗和舒张功能进行相关性分析,快速充盈期整体、中间段能量损耗与E、LAVI、E/e'呈显著正相关(p0.05);基底段能量损耗与E、e'(s)、e'(1)呈显著正相关(p0.05)。缓慢充盈期心尖段能量损耗与E、A、LAVI、E/e'存在显著正相关(p0.05)。心房收缩期整体能量损耗与E/e'呈显著正相关(p0.05),与e'(s)、e'(1)呈显著负相关(p0.05);基底段能量损耗与E/e'呈显著正相关(p0.05)。(2)对高血压组涡流和舒张功能进行相关性分析,快速充盈期二尖瓣后叶涡流循环量与E呈显著正相关(p0.05)。心房收缩期前叶涡流循环与E/e'呈显著负相关(p0.05),与e'(1)呈显著正相关(p0.05);心房收缩期前叶涡流面积与e'(s)、e'(1)呈显著正相关(p0.05),与E/e'呈显著负相关(p0.05)。心房收缩期后叶涡流循环与与A呈显著正相关(p0.05),与e'(s)呈显著负相关(p0.05)。结论1、采用Ganau分型方法,分别依据欧美人群及中国人群超声正常值进行分型,得到的构型分析结果不同。2、依照中国人群超声正常值进行高血压构型分析可以更敏感地反映左室内能量损耗变化。3、原发性高血压患者与正常对照相比心房收缩期能量损耗增加,涡流循环量增加,能量损耗和涡流改变与舒张功能变化相关。
[Abstract]:Background primary hypertension is a common clinical disease, which is characterized by higher body circulation pressure, which can cause abnormal structure and function of target organs, such as the normal structure and function of the organs such as heart, brain and kidney. The increase of ventricular post load may cause the change of flow pattern in the heart cavity and the normal flow field in the heart. Hypertensive heart disease is one of the important factors contributing to the retention of heart failure in ejection fraction. Early and accurate evaluation of left ventricular function changes is of great significance. However, the relationship between blood flow change in the heart and diastolic dysfunction and ventricular remodeling needs to be further clarified. Blood flow vector imaging (VFM) can quantify the hemodynamic changes in the heart cavity. Evaluation, calculation of the energy loss and eddy current circulation during the flow of blood flow in the heart. The analysis of the left ventricular configuration of hypertension in the past is mostly based on the Ganau classification that is in line with the standard of European and American population. However, there is no report on the hemodynamic study of the configuration characteristics of the hypertensive population in China, which needs further study. Objective 1 to compare the distribution characteristics of hypertensive configuration under Chinese and international standards, observe whether there is a difference in left heart function and hemodynamic performance under different standards.2. According to the normal values of Chinese people, the structure of hypertensive patients is analyzed, and the blood flow of left indoor energy and eddy circulation in the diastolic period of hypertensive patients is evaluated. .3, the relationship between left ventricular hemodynamic changes and diastolic function was discussed. The value of blood flow vector imaging technique in evaluating left ventricular diastolic function in hypertensive patients was analyzed. Study object hypertension group: according to the 2010 diagnostic criteria of Chinese hypertension prevention guide, 3 blood pressure measurements were carried out on different days, if no blood pressure was taken. Drugs, the systolic pressure is more than 140mmHg (lmmHg=0.133kPa) and (or) diastolic pressure more than 90mmHg, that is, the diagnosis of hypertension; if the blood pressure is lower than 140/90mmHg, there is a history of hypertension, and is using antihypertensive drugs, also diagnosed as hypertension. Excluding coronary heart disease, diabetes, heart failure, hyperlipidemia, pericardial effusion, emphysema, arrhythmia, stroke, Myocardial infarction, valvular disease, thyroid disease, congenital heart disease, anemia, cardiomyopathy, connective tissue disease, pregnancy or lactating women, abnormal electrocardiogram, malignant tumors and other severe systemic diseases, 63 hypertensive patients. A total of 23 healthy volunteers were matched with the age and sex of the hypertension group. Method 1, Basic information collection: including the subjects' name, sex, age, height, weight, blood pressure, heart rate, smoking and alcohol history, blood lipid, blood sugar, medical history and other basic information.2, ultrasonic image acquisition: (1) use Japanese Hitachi Aloka Prosound F75 color Doppler ultrasound diagnostic instrument, the subjects take the left lying position, connect the limb lead, and record the electrocardiogram synchronously, The long axis section of the parastenal left ventricle, the two cavities of the apical cavity, the dynamic image of the four cavities of the apex, left the left atrial diameter (LAD), the internal diameter of the left ventricle (AO), the left ventricular end diastolic diameter (LVID), the left ventricular posterior wall (LPW) and the thickness of the interventricular septum (IVS), and the calculation of the relative ventricular wall thickness (RWT) and left ventricular mass (LVM). Left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Left atrial volume index (LAV) was measured by biplane Simpson method and left atrial volume index (LAVI) was calculated. (2) measurement of early diastolic E wave velocity (E), late diastolic A wave velocity (A) of mitral valve, early diastolic blood flow deceleration time (DT) of mitral valve and E/A. measurement of three tip reverse flow velocity were measured. Degree (TRV). (3) measurement of the early diastolic mitral annular interventricular septum, the peak velocity of the lateral wall myocardial motion, respectively E'(s), E' (1), the mean value E'and E/e'.3, the blood flow vector imaging measurement: using the VFM mode, collecting the dynamic images of the three cavities of the apical three cavities, leaving the continuous three cardiac cycles, and introducing the workstation for offline analysis. Reference image scale, will be used The left ventricle was divided into three segments of the apical, middle and basal segments, combined with the time flow curve and the aortic valve, the opening and closing of the mitral valve, the constant volume diastolic phase, the rapid filling period, the slow filling period and the atrial systole, and the measurement of the energy loss of the left ventricle and Duan Ping in different periods, and the eddy circulation and the eddy area of.4 in each period. SPSS23.0 software was used to analyze the results of statistical analysis 1, basic data comparison (1) according to Chinese standards for hypertension configuration analysis, NG group 27 cases (43%), CR group 5 cases (8%), EH group 21 cases (33%), CH group 10 cases (16%). According to international standard, hypertension configuration analysis, NG group 17 cases (27%), CR group 23 cases (36%), EH group cases, CH group instances (27%) there were statistical differences (P0.05) with the results of Chinese population structure analysis. (2) there was no significant difference in heart rate between the hypertension group and the control group (P0.05). Compared with the control group, the systolic pressure and diastolic pressure in the hypertension group and the subgroups increased (P0.05); the systolic pressure and diastolic pressure between the subgroups were not statistically different (P0.05).2, according to the Chinese standard ultrasound examination. Comparison of common indexes (1) left ventricular wall thickness: LPW, IVS and RWT in hypertension group were larger than those of control group, the difference was statistically significant (P0.05). (2) the inner diameter of the heart cavity: hypertension group LAD, AO was larger than the control group (P0.05). There was no statistical difference between the hypertension group and the control group (P0.05). (3) the left ventricular mass: hypertension group LVM, LVMI was compared. The difference was statistically significant (P0.05). (4) left atrial volume: hypertension group LAV, LAVI higher than the control group (P0.05), EH group and CH group left chamber volume increased compared with the NG group, the difference was statistically significant (P0.05). (5) left ventricular ejection fraction: no statistical difference between the hypertension group and the control group (P0.05). (6) the diastolic mitral valve flow velocity: high There was no significant difference in E between the blood pressure group and the control group (P0.05). Compared with the control group, the E/A decreased (P0.05), the NG group, and the EH group E/A decreased (P0.05). Compared with the control group, the A of the hypertension group and the subgroups increased (P0.05). (7) the mitral annulus myocardium movement speed of the diastolic phase was lower than the control group, and the hypertension group and the sub group E'(1) were all reduced. 0.05); E'(s) and E' (1) increased in group EH (P0.05). Compared with the control group, the hypertension and each subgroup E/e'increased (P0.05). (8) three apical flow reverse flow velocity: compared with the control group, there was no statistical difference between the hypertension group and the subgroups (P0.05).3, according to the standard energy loss (1) in China (1) of the ISO diastolic phase: hypertension compared with the control group, hypertension The average energy loss in the left ventricle, basal segment, middle segment and apical segment was not statistically different (P0.05). (2) rapid filling period and slow filling period: compared with the control group, the average energy loss in the left ventricle, basal segment, middle segment and apical segment of the hypertension group was not statistically different (P0.05). (3) the systolic phase of the atrium was compared with the control group, left by the hypertension group The average energy loss in the basal segment and middle segment increased (P0.05). The mean energy loss of the apex segment was not significantly different from the control group (P0.05). Compared with the control group, the energy loss in the middle segment of the hypertensive NG group increased (P0.05), the basal segment of the EH group and the energy loss in the middle segment increased (P0.05); the energy loss in the middle segment of the CH group was higher than that in the NG group, and the EH group decreased. The difference was statistically significant (P0.05).4, according to Chinese standard eddy current comparison (1) ISO diastolic phase: there was no significant eddy current in both hypertension group and control group. (2) rapid filling period: compared with the control group, there was no statistical difference (P0.05) in the volume of eddy current and eddy current in the posterior lobe of the hypertension group (P0.05); there was no statistical difference between the subgroups (P0.05). 3) slow filling period: compared with the control group, there was no statistical difference in the volume of eddy current and the area of eddy current in the hypertension group (P0.05); there was no statistical difference between the subgroups (P0.05). (4) the atrial systolic phase: compared with the control group, the eddy circulation and the eddy area of the posterior lobe of the hypertension group increased (P0.05), the NG group, and the eddy circulation of the posterior lobe of the EH group The volume of eddy current and the area of eddy current increased (P0.05). There was no significant difference in eddy current circulation and eddy area in the anterior lobe of the hypertension group (P0.05).5. The configuration analysis (1) analyzed the Chinese standard and the international standard results, compared the NG group and CH group under different standards. The cardiac function indexes were LAVI, E, A, E/A, TRV, E'(s). The mean energy loss of the whole left ventricle and each segment between the Chinese standard and the international standard group (P0.05). There was no statistical difference between the left ventricular eddy current cycle and the area of the eddy current (P0.05). (2) the energy loss was analyzed according to the international standard. The average energy loss of the whole left ventricle and each segment between the subgroups and the control groups was no more. Study difference (P0.05). (3) according to the international standard, the eddy current hypertension subgroup analysis, the atrial systolic NG group, the CR group of the mitral valve posterior lobe, the eddy circulation volume and the eddy area increased (P0.05).6, correlation analysis (1) the correlation analysis of the energy loss and the relaxation function of the hypertension group, the rapid filling period, the middle segment energy. Loss was significantly positively correlated with E, LAVI and E/e'(P0.05); the energy loss in the basal segment was significantly positively correlated with E, E' (s) and E'(1). The energy loss in the bottom segment was positively correlated with the E/e'(P0.05). (2) the correlation between the eddy current and diastolic function of the hypertension group was analyzed. The eddy circulation in the posterior lobe of the mitral valve was significantly positively correlated with the E (P0.05). There was a significant negative correlation between the anterior lobe of the atrial systole and E/e' (P0.05), and the positive correlation with E'(1) (P0.05), and the atrial contraction. There was a significant positive correlation between E'(s), E' (1) and E/e'(P0.05). There was a significant positive correlation between the eddy circulation and A (P0.05) after the atrial systole (P0.05), and a significant negative correlation with E' (s). Conclusion 1, a Ganau classification method was used to classify the normal values of American and European populations and Chinese people, respectively. The results of the configuration analysis were different.2. According to the normal values of the Chinese people, the analysis of the hypertension configuration could be more sensitive to the change of the energy loss in the left indoor.3. The energy loss of the patients with primary hypertension and the normal contrast of the atrial systole increased, the volume of eddy circulation increased, and the energy loss and eddy current change were related to the diastolic function.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1
本文编号：2121661
[Abstract]:Background primary hypertension is a common clinical disease, which is characterized by higher body circulation pressure, which can cause abnormal structure and function of target organs, such as the normal structure and function of the organs such as heart, brain and kidney. The increase of ventricular post load may cause the change of flow pattern in the heart cavity and the normal flow field in the heart. Hypertensive heart disease is one of the important factors contributing to the retention of heart failure in ejection fraction. Early and accurate evaluation of left ventricular function changes is of great significance. However, the relationship between blood flow change in the heart and diastolic dysfunction and ventricular remodeling needs to be further clarified. Blood flow vector imaging (VFM) can quantify the hemodynamic changes in the heart cavity. Evaluation, calculation of the energy loss and eddy current circulation during the flow of blood flow in the heart. The analysis of the left ventricular configuration of hypertension in the past is mostly based on the Ganau classification that is in line with the standard of European and American population. However, there is no report on the hemodynamic study of the configuration characteristics of the hypertensive population in China, which needs further study. Objective 1 to compare the distribution characteristics of hypertensive configuration under Chinese and international standards, observe whether there is a difference in left heart function and hemodynamic performance under different standards.2. According to the normal values of Chinese people, the structure of hypertensive patients is analyzed, and the blood flow of left indoor energy and eddy circulation in the diastolic period of hypertensive patients is evaluated. .3, the relationship between left ventricular hemodynamic changes and diastolic function was discussed. The value of blood flow vector imaging technique in evaluating left ventricular diastolic function in hypertensive patients was analyzed. Study object hypertension group: according to the 2010 diagnostic criteria of Chinese hypertension prevention guide, 3 blood pressure measurements were carried out on different days, if no blood pressure was taken. Drugs, the systolic pressure is more than 140mmHg (lmmHg=0.133kPa) and (or) diastolic pressure more than 90mmHg, that is, the diagnosis of hypertension; if the blood pressure is lower than 140/90mmHg, there is a history of hypertension, and is using antihypertensive drugs, also diagnosed as hypertension. Excluding coronary heart disease, diabetes, heart failure, hyperlipidemia, pericardial effusion, emphysema, arrhythmia, stroke, Myocardial infarction, valvular disease, thyroid disease, congenital heart disease, anemia, cardiomyopathy, connective tissue disease, pregnancy or lactating women, abnormal electrocardiogram, malignant tumors and other severe systemic diseases, 63 hypertensive patients. A total of 23 healthy volunteers were matched with the age and sex of the hypertension group. Method 1, Basic information collection: including the subjects' name, sex, age, height, weight, blood pressure, heart rate, smoking and alcohol history, blood lipid, blood sugar, medical history and other basic information.2, ultrasonic image acquisition: (1) use Japanese Hitachi Aloka Prosound F75 color Doppler ultrasound diagnostic instrument, the subjects take the left lying position, connect the limb lead, and record the electrocardiogram synchronously, The long axis section of the parastenal left ventricle, the two cavities of the apical cavity, the dynamic image of the four cavities of the apex, left the left atrial diameter (LAD), the internal diameter of the left ventricle (AO), the left ventricular end diastolic diameter (LVID), the left ventricular posterior wall (LPW) and the thickness of the interventricular septum (IVS), and the calculation of the relative ventricular wall thickness (RWT) and left ventricular mass (LVM). Left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Left atrial volume index (LAV) was measured by biplane Simpson method and left atrial volume index (LAVI) was calculated. (2) measurement of early diastolic E wave velocity (E), late diastolic A wave velocity (A) of mitral valve, early diastolic blood flow deceleration time (DT) of mitral valve and E/A. measurement of three tip reverse flow velocity were measured. Degree (TRV). (3) measurement of the early diastolic mitral annular interventricular septum, the peak velocity of the lateral wall myocardial motion, respectively E'(s), E' (1), the mean value E'and E/e'.3, the blood flow vector imaging measurement: using the VFM mode, collecting the dynamic images of the three cavities of the apical three cavities, leaving the continuous three cardiac cycles, and introducing the workstation for offline analysis. Reference image scale, will be used The left ventricle was divided into three segments of the apical, middle and basal segments, combined with the time flow curve and the aortic valve, the opening and closing of the mitral valve, the constant volume diastolic phase, the rapid filling period, the slow filling period and the atrial systole, and the measurement of the energy loss of the left ventricle and Duan Ping in different periods, and the eddy circulation and the eddy area of.4 in each period. SPSS23.0 software was used to analyze the results of statistical analysis 1, basic data comparison (1) according to Chinese standards for hypertension configuration analysis, NG group 27 cases (43%), CR group 5 cases (8%), EH group 21 cases (33%), CH group 10 cases (16%). According to international standard, hypertension configuration analysis, NG group 17 cases (27%), CR group 23 cases (36%), EH group cases, CH group instances (27%) there were statistical differences (P0.05) with the results of Chinese population structure analysis. (2) there was no significant difference in heart rate between the hypertension group and the control group (P0.05). Compared with the control group, the systolic pressure and diastolic pressure in the hypertension group and the subgroups increased (P0.05); the systolic pressure and diastolic pressure between the subgroups were not statistically different (P0.05).2, according to the Chinese standard ultrasound examination. Comparison of common indexes (1) left ventricular wall thickness: LPW, IVS and RWT in hypertension group were larger than those of control group, the difference was statistically significant (P0.05). (2) the inner diameter of the heart cavity: hypertension group LAD, AO was larger than the control group (P0.05). There was no statistical difference between the hypertension group and the control group (P0.05). (3) the left ventricular mass: hypertension group LVM, LVMI was compared. The difference was statistically significant (P0.05). (4) left atrial volume: hypertension group LAV, LAVI higher than the control group (P0.05), EH group and CH group left chamber volume increased compared with the NG group, the difference was statistically significant (P0.05). (5) left ventricular ejection fraction: no statistical difference between the hypertension group and the control group (P0.05). (6) the diastolic mitral valve flow velocity: high There was no significant difference in E between the blood pressure group and the control group (P0.05). Compared with the control group, the E/A decreased (P0.05), the NG group, and the EH group E/A decreased (P0.05). Compared with the control group, the A of the hypertension group and the subgroups increased (P0.05). (7) the mitral annulus myocardium movement speed of the diastolic phase was lower than the control group, and the hypertension group and the sub group E'(1) were all reduced. 0.05); E'(s) and E' (1) increased in group EH (P0.05). Compared with the control group, the hypertension and each subgroup E/e'increased (P0.05). (8) three apical flow reverse flow velocity: compared with the control group, there was no statistical difference between the hypertension group and the subgroups (P0.05).3, according to the standard energy loss (1) in China (1) of the ISO diastolic phase: hypertension compared with the control group, hypertension The average energy loss in the left ventricle, basal segment, middle segment and apical segment was not statistically different (P0.05). (2) rapid filling period and slow filling period: compared with the control group, the average energy loss in the left ventricle, basal segment, middle segment and apical segment of the hypertension group was not statistically different (P0.05). (3) the systolic phase of the atrium was compared with the control group, left by the hypertension group The average energy loss in the basal segment and middle segment increased (P0.05). The mean energy loss of the apex segment was not significantly different from the control group (P0.05). Compared with the control group, the energy loss in the middle segment of the hypertensive NG group increased (P0.05), the basal segment of the EH group and the energy loss in the middle segment increased (P0.05); the energy loss in the middle segment of the CH group was higher than that in the NG group, and the EH group decreased. The difference was statistically significant (P0.05).4, according to Chinese standard eddy current comparison (1) ISO diastolic phase: there was no significant eddy current in both hypertension group and control group. (2) rapid filling period: compared with the control group, there was no statistical difference (P0.05) in the volume of eddy current and eddy current in the posterior lobe of the hypertension group (P0.05); there was no statistical difference between the subgroups (P0.05). 3) slow filling period: compared with the control group, there was no statistical difference in the volume of eddy current and the area of eddy current in the hypertension group (P0.05); there was no statistical difference between the subgroups (P0.05). (4) the atrial systolic phase: compared with the control group, the eddy circulation and the eddy area of the posterior lobe of the hypertension group increased (P0.05), the NG group, and the eddy circulation of the posterior lobe of the EH group The volume of eddy current and the area of eddy current increased (P0.05). There was no significant difference in eddy current circulation and eddy area in the anterior lobe of the hypertension group (P0.05).5. The configuration analysis (1) analyzed the Chinese standard and the international standard results, compared the NG group and CH group under different standards. The cardiac function indexes were LAVI, E, A, E/A, TRV, E'(s). The mean energy loss of the whole left ventricle and each segment between the Chinese standard and the international standard group (P0.05). There was no statistical difference between the left ventricular eddy current cycle and the area of the eddy current (P0.05). (2) the energy loss was analyzed according to the international standard. The average energy loss of the whole left ventricle and each segment between the subgroups and the control groups was no more. Study difference (P0.05). (3) according to the international standard, the eddy current hypertension subgroup analysis, the atrial systolic NG group, the CR group of the mitral valve posterior lobe, the eddy circulation volume and the eddy area increased (P0.05).6, correlation analysis (1) the correlation analysis of the energy loss and the relaxation function of the hypertension group, the rapid filling period, the middle segment energy. Loss was significantly positively correlated with E, LAVI and E/e'(P0.05); the energy loss in the basal segment was significantly positively correlated with E, E' (s) and E'(1). The energy loss in the bottom segment was positively correlated with the E/e'(P0.05). (2) the correlation between the eddy current and diastolic function of the hypertension group was analyzed. The eddy circulation in the posterior lobe of the mitral valve was significantly positively correlated with the E (P0.05). There was a significant negative correlation between the anterior lobe of the atrial systole and E/e' (P0.05), and the positive correlation with E'(1) (P0.05), and the atrial contraction. There was a significant positive correlation between E'(s), E' (1) and E/e'(P0.05). There was a significant positive correlation between the eddy circulation and A (P0.05) after the atrial systole (P0.05), and a significant negative correlation with E' (s). Conclusion 1, a Ganau classification method was used to classify the normal values of American and European populations and Chinese people, respectively. The results of the configuration analysis were different.2. According to the normal values of the Chinese people, the analysis of the hypertension configuration could be more sensitive to the change of the energy loss in the left indoor.3. The energy loss of the patients with primary hypertension and the normal contrast of the atrial systole increased, the volume of eddy circulation increased, and the energy loss and eddy current change were related to the diastolic function.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1
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