拉普拉塔大学患有I期高血压的年轻男学生的左心室结构与功能
[Left ventricular structure and function in young male students of La Plata University with stage I hypertension].
作者信息
Escudero E M, De Lena S, Cingolani H E
机构信息
Centro de Investigaciones Cardiovasculares, Facultad de Ciencias Médicas, Universidad Nacional de La Plata.
出版信息
Medicina (B Aires). 1997;57(2):181-90.
From an homogeneous population of 219 male medical students of La Plata University (20.9 +/- 1.6 years) who underwent a blood pressure screening, 34 were selected for measurements of left ventricular structure and function. Considering the JNC-V classification, samples from two groups were selected for comparisons: Optimal blood pressure (OBP) (21 males, 20.33 +/- 1.8 years) and Hypertensives stage I (H) (13 males, 20.85 +/- .66 years). The H showed values of body mass index (BMI) and heart rate (HR) higher than OBP (BMI OBP: 22.5 +/- 0.38 kg/m2, H: 24.26 +/- 0.84 kg/m2 -p < 0.04; HR OBP: 69.9 +/- 1.53 lat/min-H 80.5 +/- 3.58 lat/min -p < 0.03). Although the H were not reaching values of left ventricular mass index (LVMI) or septal (S) and posterior wall thickness to be considered hypertrophics, they were exceeding the OBP group (LVMI OBP: 89.6 +/- 3.33 g/m2, H: 124.5 +/- 6 g/m2 -p < 0.01; S OBP: 8.7 +/- 0.17 mm, H: 11.5 +/- 0.04 mm; P OBP: 7.9 +/- 0.18 mm, H: 10 +/- 0.13 mm -p < 0.01). Cardiac index (CI) was increased in H (OBP: 3.3 +/- 0.14 l/min/m2, H: 4.8 +/- 0.36 l/min/m2 -p < 0.01) supporting the existence of a hyperkinetic circulatory phase. OBP showed total peripheral resistance (TPR) higher than H group (OBP: 17 +/- 0.8 mmHg/l.min.m2, H: 13 +/- 1 mmHg/l.min.m2 -p < 0.008). Left ventricular (LV) systolic function indexes were not different in the two groups analyzed. The pattern of left ventricular late filling was however different between the two groups. The area of late diastolic flow (Area A) was lower in OBP (OBP: 2.64 +/- 0.09 cm2, H: 3.78 +/- 0.95 cm2 -p < 0.01) independently of HR value (adjusted mean OBP: 2.9 +/- 0.09 cm2, H: 3.52 +/- 0.95 cm2 -p < 0.01). The early filling fraction (EFF) was also detecting a significant shift to more prominent late diastolic filling in H (OBP 0.72 +/- 0.06%, H: 0.64 +/- 0.01% -p < 0.01) independently of HR values (adjusted mean PAO: 0.71 +/- 0.96%, H: 0.65 +/- 0.01% -p < 0.01). Healthy young males with hypertension stage I have similar LV systolic function, increased CI, LVMI, LV wall thickness, decreased TPR and evidence of impaired LV filling with shift of the pattern of filling to a late flow.
从拉普拉塔大学219名接受血压筛查的男性医学生（20.9±1.6岁）这一同质群体中，选取34人进行左心室结构和功能测量。根据美国国家联合委员会（JNC-V）分类，选取两组样本进行比较：最佳血压（OBP）组（21名男性，20.33±1.8岁）和高血压I期（H）组（13名男性，20.85±0.66岁）。H组的体重指数（BMI）和心率（HR）值高于OBP组（BMI OBP：22.5±0.38kg/m²，H组：24.26±0.84kg/m² -p<0.04；HR OBP：69.9±1.53次/分钟 - H组80.5±3.58次/分钟 -p<0.03）。虽然H组的左心室质量指数（LVMI）、室间隔（S）和后壁厚度尚未达到可视为肥厚的数值，但已超过OBP组（LVMI OBP：89.6±3.33g/m²，H组：124.5±6g/m² -p<0.01；S OBP：8.7±0.17mm，H组：11.5±0.04mm；P OBP：7.9±0.18mm，H组：10±0.13mm -p<0.01）。H组的心指数（CI）升高（OBP组：3.3±0.14l/min/m²，H组：4.8±0.36l/min/m² -p<0.01），支持高动力循环期的存在。OBP组的总外周阻力（TPR）高于H组（OBP组：17±0.8mmHg/l.min.m²，H组：13±1mmHg/l.min.m² -p<0.008）。在分析的两组中，左心室（LV）收缩功能指标无差异。然而，两组之间左心室晚期充盈模式不同。OBP组的舒张晚期血流面积（面积A）较低（OBP组：2.64±0.09cm²，H组：3.78±0.95cm² -p<0.01），与心率值无关（调整后均值OBP组：2.9±0.09cm²，H组：3.52±0.95cm² -p<0.01）。早期充盈分数（EFF）也显示H组舒张晚期充盈明显向更显著方向转变（OBP组0.72±0.06%，H组：0.64±0.01% -p<0.01），与心率值无关（调整后均值PAO组：0.71±0.96%，H组：0.65±0.01% -p<0.01）。患有高血压I期的健康年轻男性具有相似的左心室收缩功能、升高的CI、LVMI、左心室壁厚度、降低的TPR以及左心室充盈受损的证据，且充盈模式向晚期血流转变。
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