CAJ | 학술논문

目的探讨动态血压水平和血压变异性与反映心脏整体功能的指标心肌做功指数(MPI)的关系.方法连续入选2013年1至9月北京大学第三医院心血管内科就诊未经治疗的高血压患者81例,行24 h动态血压监测和超声心动图检查.计算得到所有患者的MPI,公式为MPI=(等容收缩时间+等容舒张时间)/射血时间.根据左心室MPI将患者分为MPI＞0.47组(n=39)和MPI≤0.47组(n=42),比较两组患者24 h、日间和夜间血压的平均值及标准差,以标准差代表血压变异性.采用多因素线性回归分析确定MPI的独立相关因素.结果 MPI＞ 0.47组高血压患者24 h和日间平均收缩压[分别为(130.1±8.7)和(134.0±8.2) mmHg(1 mmHg=0.133 kPa)],24h、日间和夜间平均舒张压[(89.1±6.3)、(90.9±6.4)和(83.1±9.9)mmHg],24 h和日间收缩压标准差[(13.7±3.3)和(14.2±3.5) mmHg]均明显高于MPI≤0.47组[分别为(124.8±8.7)、(126.7±8.8)、(84.5±7.1)、(86.2±7.4)、(76.4±7.5)、(11.8±2.1)和(10.4±1.9) mmHg,P均＜0.05].多因素回归分析显示,24 h平均舒张压(β=0.239,P=0.007)、24h收缩压标准差(β=0.333,P＜0.001)与MPI独立相关,其他与MPI独立相关的因素为左心室重量指数和二尖瓣环侧壁舒张早期运动峰速度.结论高血压患者舒张压水平的升高和收缩压变异性的增加伴随左心室整体功能的下降.
목적 탐토동태혈압수평화혈압변이성여반영심장정체공능적지표심기주공지수(MPI)적관계.방법 련속입선2013년1지9월북경대학제삼의원심혈관내과취진미경치료적고혈압환자81례,행24 h동태혈압감측화초성심동도검사.계산득도소유환자적MPI,공식위MPI=(등용수축시간+등용서장시간)/사혈시간.근거좌심실MPI장환자분위MPI＞0.47조(n=39)화MPI≤0.47조(n=42),비교량조환자24 h、일간화야간혈압적평균치급표준차,이표준차대표혈압변이성.채용다인소선성회귀분석학정MPI적독립상관인소.결과 MPI＞ 0.47조고혈압환자24 h화일간평균수축압[분별위(130.1±8.7)화(134.0±8.2) mmHg(1 mmHg=0.133 kPa)],24h、일간화야간평균서장압[(89.1±6.3)、(90.9±6.4)화(83.1±9.9)mmHg],24 h화일간수축압표준차[(13.7±3.3)화(14.2±3.5) mmHg]균명현고우MPI≤0.47조[분별위(124.8±8.7)、(126.7±8.8)、(84.5±7.1)、(86.2±7.4)、(76.4±7.5)、(11.8±2.1)화(10.4±1.9) mmHg,P균＜0.05].다인소회귀분석현시,24 h평균서장압(β=0.239,P=0.007)、24h수축압표준차(β=0.333,P＜0.001)여MPI독립상관,기타여MPI독립상관적인소위좌심실중량지수화이첨판배측벽서장조기운동봉속도.결론 고혈압환자서장압수평적승고화수축압변이성적증가반수좌심실정체공능적하강.
Objective To observe the association between ambulatory blood pressure levels and blood pressure variability (BPV) with myocardial performance index (MPI) in untreated hypertensive patients.Methods From January to September 2013,a total of 81 untreated hypertensive patients were included in this study.All patients received ambulatory blood pressure monitoring and echocardiography measurements.MPI was determined in all patients by the following formula:MPI =(isovolumic contraction time + isovolumic relaxation time)/ejection time.The patients were divided into two groups according to left ventricular MPI:patients with MPI ＞ 0.47 (n =39) and patients with MPI ≤ 0.47 (n =42).The mean levels and standard deviation (SD) of 24 h,daytime and nighttime blood pressures were compared between the two groups.SD was used to express BPV.Determinants of MPI were identified by multivariate regression analysis.Results 24 h and daytime systolic blood pressure,24 h,daytime and nighttime diastolic blood pressure,as well as SD of 24 h and daytime systolic blood pressure ((130.1 ± 8.7),(134.0 ± 8.2),(89.1 ±6.3),(90.9 ±6.4),(83.1 ±9.9),(13.7 ± 3.3) and(14.2 ± 3.5) mmHg(1 mmHg =0.133 kPa),respectively) were significantly higher in patients with MPI ＞ 0.47 than those ((124.8 ± 8.7),(126.7 ±8.8),(84.5 ±7.1),(86.2 ± 7.4),(76.4 ± 7.5),(11.8 ±2.1) and(10.4 ± 1.9) mmHg,respectively) in patients with MPI≤0.47 (all P ＜ 0.05).Multivariate regression analysis showed that 24 h diastolic blood pressure (β =0.239,P =0.007) and SD of 24 h systolic blood pressure (β =0.333,P ＜0.001),left ventricular mass index and early diastolic mitral annular velocity were independently associated with MPI.Conclusion The increase of diastolic blood pressure and systolic BPV are associated with the deterioration of left ventricular function.