原发性高血压左室肥厚患者心率振荡现象及临床意义

目的探讨原发性高血压合并左心室肥厚（LVH）患者心率振荡现象（HRT）及临床意义。方法人选276例原发性高血压患者，均进行心脏彩超检查及24h心电（Holter）记录，计算左心室重量、左心室重量指数（LVMI）、震荡初始（TO）及震荡斜率（偈）。以LVMI男性〉125g／m2．女性〉120g／m。和（或）室间隔厚度（IVST）〉12mm作为左室肥厚（LVH）标准，分为LVH组及左室正常组。结果LVH组TO及TS分别为（1．19±0．84）％及（4．23±0．85）ms／RR，左室正常组分别为（-0．54±0．86）％及（6．81±1．22）ms／RR，两组比较差异有统计学意义，P〈0．01。LVH组异常TO及偈比率与左室正常组比较，差异有统计学意义（P〈0．01）。TO与左室射血分数（LVEF）、左室舒张末期内径（LVEDD）及LVMI显著相关，P〈0．05。TS与LVEF、IVST显著相关，P〈0．05；与LVEDD及LVMI显著相关，P〈0．01。结论原发性高血压伴LVH患者的HRT明显减弱，提示高血压合并LVH时，自主神经功能受损加重。

Clinical context of heart rate turbulence in essential hypertension with left ventricular hypertrophy

Objective To investigate the characteristics of heart rate turbulence （HRT） in essential hypertension with left ventricular hypertrophy （LVH）. Methods 276 essential hypertension patients were enrolled in this study. All consent information was obtained. All patients were performed echocardiographic measurement of left ventricular mass index （LVMI）, and then they were divided into two groups by LVMI, which were LVH group and normal left ventricular group. All patients of both groups were undergone 24-hour Hoher recording, the Holler files were processed with software of computer to obtain the value of turbulence onset （TO）, turbulence slope （TS） and the value of heart rate variability SDNN. Results To and TS were （1.19±0.84）% and （4.23±0.85） ms/RR, respectively, in LVH group, （-0.54±0.86）% and （6.81±1.22）ms/RR, respectively, in normal left ventrieular group. There was significant difference in TO and ＇IS in LVH group compared with those in normal left ventrieular group,P〈0.01. There was significant relationship between TO and left ventrieular ejection fraction （LVEF）, left ventrieular end diastolic dimension （LVEDD） and LVMI,P〈0.05. There was significant relationship between TS and LVEF and interventrieular septal thickness （IVST）,P〈0.05. And there was very significant relationship between TS and LVEDD and LVMI,P〈0.01. Conclusion HRT is dramatically blunted in essential hypertension with LVH.