Karasek E, Witkowska M
Katedra i Klinika Kardiologii AM we Wrocławiu.
Pol Arch Med Wewn. 2000 Jan-Feb;103(1-2):23-33.
Increased pressure load and neurohumoral activation are main factors involved in pathomechanism of left ventricular hypertrophy (LVH) in hypertension (HT). To gain insight into the involvement of neurohumoral factors responsible for cardiac hypertrophy, plasma level of aldosterone (Aldo), plasma renin activity (PRA), insulin-like growth factor-1 (IGF-1), pro-endothelin-1 (pro-ET) and atrial natriuretic peptide (ANP) were measured in HT patients (pts) and compared between pts with and without LVH. Also relationships between neurohormones and LV mass index (LVMI), mean blood pressure (MBP) were assessed separately in HT pts with and without LVH. 121 HT patients (pts) of age 17-79 (mean 48 +/- 15.3) were divided into three groups: 1-53 pts with mild HT, 2-44 pts with moderate HT and 3-24 pts with severe HT. Each of the group was divided into pts with and without LVH further all HT pts were divided into two groups; with and without LVH. Control group consisted of 39 healthy normotensives. LV mass was assessed echocardiographically and plasma levels of IGF-1, PRA, Aldo, pro-ET, and ANP were measured by radioimmunoassay in each pts and controls. LVH was found in 35.8% pts with mild HT, in 68.18% pts with moderate HT and in 100% pts with severe HT. The level of all measured neurohormones were significantly higher in pts with LVH compared to pts without LVH (p < 0.001). In pts with LVH there was significant correlation between LVMI and IGF-1, PRA, Aldo, pro-ET-1 and ANP, contrary to pts without LVH in which such correlations was not found. In pts with LVH there was also significant correlation between MBP and IGF-1, PRA, ANP and pro-ET-1. Increased plasma level of PRA, Aldo, IGF-1, pro-ET-1 and ANP in HT pts with LVH and significant correlation between measured neurohormones and LVMI suggests their contribution to LVH in HT pts. Significant correlation between LVMI, MBP and IGF-1 level, PRA and ANP indicate interplay between hemodynamic and neuroendocrine factors in pathomechanism of LVH.
压力负荷增加和神经体液激活是高血压（HT）患者左心室肥厚（LVH）发病机制中的主要因素。为深入了解导致心脏肥厚的神经体液因素，我们检测了高血压患者血浆醛固酮（Aldo）水平、血浆肾素活性（PRA）、胰岛素样生长因子-1（IGF-1）、前内皮素-1（pro-ET）和心钠素（ANP），并比较了有LVH和无LVH患者之间的差异。同时，分别评估了有LVH和无LVH的高血压患者神经激素与左心室质量指数（LVMI）、平均血压（MBP）之间的关系。121例年龄在17 - 79岁（平均48±15.3岁）的高血压患者被分为三组：1组-53例轻度高血压患者，2组-44例中度高血压患者，3组-24例重度高血压患者。每组再进一步分为有LVH和无LVH的患者，所有高血压患者共分为两组：有LVH和无LVH。对照组由39名健康血压正常者组成。通过超声心动图评估左心室质量，采用放射免疫分析法测定每位患者和对照组的血浆IGF-1、PRA、Aldo、pro-ET和ANP水平。轻度高血压患者中35.％发现有LVH，中度高血压患者中68.18％发现有LVH，重度高血压患者中100％发现有LVH。与无LVH的患者相比，有LVH患者的所有检测神经激素水平均显著升高（p < 0.001）。在有LVH的患者中，LVMI与IGF-1、PRA、Aldo、pro-ET-1和ANP之间存在显著相关性，而在无LVH的患者中未发现这种相关性。在有LVH的患者中，MBP与IGF-1、PRA、ANP和pro-ET-1之间也存在显著相关性。有LVH的高血压患者血浆PRA、Aldo、IGF-1、pro-ET-1和ANP水平升高，且所测神经激素与LVMI之间存在显著相关性，提示它们在高血压患者LVH发病机制中起作用。LVMI、MBP与IGF-1水平、PRA和ANP之间的显著相关性表明血流动力学和神经内分泌因素在LVH发病机制中相互作用。
