舒张压达到3级的青年高血压患者心脏结构和功能改变

目的 探究青年高血压患者中，单纯舒张压达到3级的高血压（DBP）和合并收缩压达到3级的高血压（DBP+SBP）两种类型的高血压对心脏结构和功能的影响情况。 方法 收集健康对照组（CON）93例、DBP组86例、DBP+SBP组101例，利用超声心动图检测各组的心脏结构、功能，计算左心室质量分数（LVMI）和相对室壁厚度（RWT），比较三组人群心脏结构和功能的差异。 结果 DBP组、DBP+SBP组患者体质量指数（BMI）、吸烟史、家族史均比CON组高（均P<0.05），而2组间均无明显差异。DBP组的收缩压、舒张压、平均动脉压均高于CON组（均P<0.01）。而DBP+SBP组的收缩压、平均动脉压均高于DBP组（均P<0.01）。但DBP组与DBP+SBP组中的舒张压未见明显差异。3组中代表心脏结构的左室短轴横径、左室短轴前后径、右室前后径、右室横径、左房横径、右房横径均无明显差异。但与CON组相比，DBP组与DBP+SBP组的左房前后径均增加（均P<0.05），而后两者组间无明显差异。代表心脏外大血管结构主动脉内径、肺动脉内径也无明显差异。三组中的射血分数（EF）、短轴缩短率（FS）均无明显差异。与CON组相比，DBP 组和DBP+SBP组的E/A值均降低（均P<0.05）。但后2组组间无明显差异。 结论 舒张压达到3级的青年高血压患者，可出现左心室肥厚、左心房前后径增加等结构改变，同时左心室的舒张能力显著下降。而是否合并收缩压升高对上述改变无明显影响。

Change of cardiac structure and function in young patients with stage 3 diastolic hypertension

AIM To explore the effects of stage 3 hypertension on the cardiac structure and function in young patients with isolated diastolic blood pressure up to the range or with both diastolic blood pressure and systolic blood pressure up to the range. METHODS Ninety-three healthy subjects were recruited in control group, 86 subjects were recruited in isolated diastolic blood pressure (DBP) group and 101 subjects were recruited in both diastolic blood pressure and systolic blood pressure (DBP+SBP) group. The heart structure and function were measured by echocardiography and left ventricular mass fraction (LVMI) and relative wall thickness (RWT) were calculated by data from echocardiograph measurement. The differences of the heart structure and function were compared between the three groups. RESULTS Compared with those in control group, the levels of SBP, DBP and mean blood pressure (MBP) were increased in DBP group. Compared with those in DBP group, the levels of SBP and MBP in DBP + SBP group were higher, but there was no marked difference in the DBP level （P<0.05）. The cardiac structure analyzed by echocardiography showed that between the three groups there were no marked differences in the left ventricular transverse or anteroposterior diameter, right ventricular transverse or anteroposterior diameter, right atrial transverse diameter and left atrial transverse diameter. But the left atrium anteroposterior diameter in DBP group or DBP+SBP group was higher than that in control group, but there was no marked difference between the former two groups （P<0.01）.The analysis of related left ventricular hypertrophy showed that the thickness of ventricular septum, the thickness of left ventricular posterior wall, LVMI and RWT in DBP group or DBP + SBP group were higher than those in control group （P<0.05）, but there was no significant difference between the former two groups. In the analysis of cardiac functions, we found that there was no marked difference in EF and FS between the three groups. However, compared with that in control group, E/A was markedly decreased in DBP group and DBP + SBP group （P<0.05）, but there was no marked difference between the latter two groups. CONCLUSION Left ventricular hypertrophy and left atrium anteroposterior diameter are increased and left ventricular diastolic ability is decreased in young patients with stage 3 diastolic hypertension, and stage 3 systolic hypertension has no clear effect on these changes.