CAJ | 학술논문

目的探讨老年原发性高血压患者左室肥厚(LVH)及舒张功能与脑钠肽(BNP)水平的关系.方法 140例老年原发性高血压患者,其中左室肥厚(LVH)组69例,非左室肥厚(NLVH)组71例,健康对照组50例.测定各组BNP浓度.常规脉冲多普勒测量二尖瓣口舒张早期血流速度(E)、舒张晚期血流速度(A),计算E/A值.应用定量组织速度成像(QTVI)技术测量左室壁二尖瓣环6个位点(侧壁和后间隔、前壁和下壁、前间隔和后壁)处的舒张早期峰值运动速度(Em)、舒张晚期峰值运动速度(Am),计算Em/Am值,同时计算6个位点平均速度(MEm、MAm)、MEm/MAm值及E/MEm值.比较3组间舒张功能指标的变化,以及BNP浓度与超声指标的关系.结果高血压NLVH组、LVH组E/MEm(11.3±1.83、15.7±1.45)及BNP浓度[(61.64±37.18)ng/L、(138.65±30.23)ng/L]较对照组升高(P＜0.05及P＜0.01);MEm[(6.32±0.94)cm/s、(4.29±0.91)cm/s]及MEm/MAm值(0.76±0.19、0.51±0.11)较对照组减低(P＜0.05及P＜0.01);高血压组BNP浓度与E/A、MEm、MEm/MAm值显著负相关(r=-0.294、r=-0.387、r=-0.422,均P＜0.01),与LVMI及E/MEm值显著正相关(r=0.342及r=0.501,均P＜0.01).结论高血压患者无论有无左室肥厚均有舒张功能减低,而LVH患者左室舒张功能障碍更为严重.联合血浆BNP浓度和超声指标有助于准确评估老年高血压患者左室肥厚和舒张功能.
목적 탐토노년원발성고혈압환자좌실비후(LVH)급서장공능여뇌납태(BNP)수평적관계.방법 140례노년원발성고혈압환자,기중좌실비후(LVH)조69례,비좌실비후(NLVH)조71례,건강대조조50례.측정각조BNP농도.상규맥충다보륵측량이첨판구서장조기혈류속도(E)、서장만기혈류속도(A),계산E/A치.응용정량조직속도성상(QTVI)기술측량좌실벽이첨판배6개위점(측벽화후간격、전벽화하벽、전간격화후벽)처적서장조기봉치운동속도(Em)、서장만기봉치운동속도(Am),계산Em/Am치,동시계산6개위점평균속도(MEm、MAm)、MEm/MAm치급E/MEm치.비교3조간서장공능지표적변화,이급BNP농도여초성지표적관계.결과 고혈압NLVH조、LVH조E/MEm(11.3±1.83、15.7±1.45)급BNP농도[(61.64±37.18)ng/L、(138.65±30.23)ng/L]교대조조승고(P＜0.05급P＜0.01);MEm[(6.32±0.94)cm/s、(4.29±0.91)cm/s]급MEm/MAm치(0.76±0.19、0.51±0.11)교대조조감저(P＜0.05급P＜0.01);고혈압조BNP농도여E/A、MEm、MEm/MAm치현저부상관(r=-0.294、r=-0.387、r=-0.422,균P＜0.01),여LVMI급E/MEm치현저정상관(r=0.342급r=0.501,균P＜0.01).결론 고혈압환자무론유무좌실비후균유서장공능감저,이LVH환자좌실서장공능장애경위엄중.연합혈장BNP농도화초성지표유조우준학평고노년고혈압환자좌실비후화서장공능.
Objective To investigate the clinical values of brain natriuretic peptide (BNP) in combination with TDI in diagnosing left ventricular hypertrophy (LVH) and impaired diastolic function in elderly hypertensive patients. Methods The 140 elderly hypertensive patients were divided into LVH group (n=69) and NLVH group (n=71). Control group consisted of 50 normal subjects. Plasma BNP level and index of echocardiography, including mitral peak flow velocity during early and late diastole (E, A), ratio of E/A, average peak velocities of six LV wall sites at mitral annuluses during early and late diastole (MEm, MAm), ratios of MEm/MAm and E/MEm were measured in all patients. The correlation of plasma BNP level with cardiac ultrasonographic findings was also examined. Results The level of BNP [(61.64±37.18)ng/L, (138. 65±30. 23)ng/L] and the ratio of E/MEm (11.3±1.83, 15.7±1.45) were significantly higher in NLVH group and LVH group than in normal group (P＜0. 05 or P＜0. 01). MEm [(6.32±0. 94)cm/s, (4.29±0. 91)cm/s]and MEm/MAm (0.76±0.19, 0.51±0. 11) were significantly lower in NLVH and LVH group than in normal group (P＜0.05 or P＜0. 01). The BNP level was negatively correlated with E/A, MEm and MEm/MAm (r=- 0. 294, r= 0. 387 and r= 0. 422, all P＜0. 01), and was positively correlated with LVMI and E/MEm (r=0.342, r=0.501, all P＜0.01). Conclusions Left ventricular diastolic function is impaired in elderly hypertension patients regardless of LVH or NLVH.Plasma BNP level in combination with echocardiography parameter is accurate to evaluate the LVHand impaired diastolic function in elderly hypertensive patients.