老年患者舒张压及血压谷峰比值与左心室舒张功能的相关性

目的 探讨老年患者动态血压变化与左心室舒张功能的关系.方法 选择2010年1月至2012年10月在北京军区总医院住院体检的患者586例.所有患者进行24 h动态血压监测,记录血压测定值,并计算平均收缩压、舒张压及谷峰比值.心脏彩色多普勒超声检测心脏收缩和舒张功能.测量二尖瓣舒张早期血流峰值速度（E峰）、舒张晚期血流峰值速度（A峰）,并计算E/A比值,分为心功能正常组（n=200）：E/A≥1;舒张性心力衰竭组（n=386）,E/A＜1;分析患者血压及相关指标与左心室舒张功能的关系.结果 舒张性心力衰竭组有78.8%患者发生高血压病、65.3%发生冠状动脉粥样硬化性心脏病（冠心病）、48.7%发生脑梗死,发病率分别高于舒张功能正常组的70%、39%、57.4%,差异均有统计学意义（P＜0.05）;糖尿病的发生无明显差异.多重线性回归分析显示,舒张功能与年龄（β=0.861）负相关,与收缩压谷峰比值（β=0.200）正相关与平均舒张压（β=-0.411）负相关（均P＜0.05）.结论 舒张性心力衰竭与高血压病、冠心病、脑梗死密切相关,与血压谷峰比值、低舒张压密切相关,对老年这一特殊人群的高血压,控制高血压预防靶器官损伤应重视血压的总体波动水平及关注低舒张压.

Association between Diastolic Blood Pressure,Trough/Peak Ratios and Left Ventricular Diastolic Function

Objective To observe the association between 24 hour ambulatory blood pressure monitoring and left ventrieular diastolic Function. Methods A total of 586 patients admitted by General Hospital of PLA Beijing Command during January 2010 and October 2012 were selected. All patients have taken 24 hour ambulatory blood pressure monitoring, 24 hours mean blood pressure and trough/peak ratio were evaluated. Transthoraeic echocardiographic examination was performed to assess the left ventrieular diastolic function. were divided into two groups ： normal group （ E/A ≥ 1, n = 200 ） and abnormal group （ E/A 〈 1, n = 386 ）. The correlation between blood pressure and related indicators and left ventricular diastolic function were analyzed. Results 78.8% patients had hypertensive disease,65.3% patients had coronary atherosclerotie cardiopathy（CHD） ,48.7% patients had cerebral infarction in diastolic heart failure group. The morbidity were higher than diastolic function in normal group, which were 70%,39% and 57.4%,wlth statistically significant difference（ P 〈 0.05 ） , respectively. Multiple linear regression showed that left wmtrleular diastolic function（LVDF） was negatively correlated with age（ 13 = 0. 861 ） , positively correlated witb systolic pressure T/P ratio（ β =0. 200）and negatively correlated with average diastolic blood pressure （β = -0.411 ）（ all P 〈 0.05 ）. Conclusion Diastolic heart failure and hypertension, coronary heart disease, cerebral infarction are closely associated with blood pressure T/P ratios, low diastolic blood pressure. Overall blood volatility and low diastolic pressure should be conc, erned to control the blood pressure and prevent the target organ injury for the hypertension of the elderly population.