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[左心室肥厚:采用血液动力学和心脏自主神经方法的生理病理体征]

[Left ventricular hypertrophy: physiopathological signs using a hemodynamic and cardio-autonomic approach].

作者信息

Nazzaro P, Merlo M, Manzari M, Soleti F, Triggiani R, Pirrelli A

机构信息

Patologia Medica II, Centro Universitario per lo Studio dello Stress, Università di Bari.

出版信息

Boll Soc Ital Biol Sper. 1992 Apr;68(4):231-8.

PMID:1463595
Abstract

The presence of left ventricular hypertrophy (LVH) in either hypertensives -H- or in normotensives -N-, suggests that not only blood pressure is determining this anatomic change, but various factors, as neural or endocrine ones, could be involved in its genesis. In order to evaluate the role of sympathetic dys-reactivity on LVH, we studied three groups of subjects: a) 12 -H- (SBP 159+/-9; DBP 99.6+/-7; FC 80+/-7) with LVH, diagnosed by echocardiogram. b) 12 -N- (SBP 138.2+/-8; DBP 83+/-2; FC 75.6+/-4) with LVH. c) 12 -N- (SBP 136.6+/-11; DBP 81.8+/-5; FC 76.3+/-5) without LVH. Using computer interfaced equipment, we measured beat to beat, hemodynamic and extra-cardiovascular autonomic functions, during a session of stressors (Mental Arithmetic, Color Word Stroop, Cold Pressure and Handgrip Tests), preceded and followed by 10' of observation. Among the various considered indexes, we evaluated the Percentual Total Activity Index (PTAI), as percentual total activity change + percentual total recovery change. Our findings point out that the PTAI of N with LVH is significantly higher for SCL, PHT, HR, SV, CO, TPR than either in H with LVH or N without LVH. These data seem to demonstrate a prolonged reactivity in N without LVH and are according to the hypothesis that LVH could also be supported by a hyper-adrenergic state with sympathetic dys-reactivity, independently from high blood pressure values.

摘要

无论是高血压患者(H组)还是血压正常者(N组)出现左心室肥厚(LVH),这表明不仅血压决定了这种解剖学变化,而且各种因素,如神经或内分泌因素,可能参与其发生过程。为了评估交感神经反应失调在左心室肥厚中的作用,我们研究了三组受试者:a)12名经超声心动图诊断为左心室肥厚的高血压患者(收缩压159±9;舒张压99.6±7;心率80±7)。b)12名有左心室肥厚的血压正常者(收缩压138.2±8;舒张压83±2;心率75.6±4)。c)12名无左心室肥厚的血压正常者(收缩压136.6±11;舒张压81.8±5;心率76.3±5)。我们使用计算机接口设备,在应激源(心算、色词斯特鲁普测验、冷压试验和握力试验)过程中,在试验前后各观察10分钟,逐搏测量血流动力学和心血管外自主神经功能。在各种考虑的指标中,我们评估了总活动百分比指数(PTAI),即总活动变化百分比+总恢复变化百分比。我们的研究结果指出,有左心室肥厚的血压正常者在交感神经皮肤反应(SCL)、外周血管阻力(PHT)、心率(HR)、每搏输出量(SV)、心输出量(CO)、总外周阻力(TPR)方面的PTAI显著高于有左心室肥厚的高血压患者或无左心室肥厚的血压正常者。这些数据似乎表明无左心室肥厚的血压正常者存在反应延长,这与左心室肥厚也可能由交感神经反应失调导致的高肾上腺素能状态所支持的假说一致,而与高血压值无关。

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