原发性高血压合并左心室肥厚对交感神经活性的影响及与血压分级的关系研究

目的探讨原发性高血压(EH)合并左心室肥厚(LVH)对交感神经活性的影响以及与血压分级的关系。方法前瞻性选取2019年1月至2020年6月期间广东医科大学附属医院收治的102例EH患者为研究对象,依据超声心动图检查是否合并LVH,分为EH组(n=57)和EH合并LVH组(n=45);依据血压测量水平和高血压分级标准,分为高血压Ⅰ级组(n=35)、高血压Ⅱ级组(n=37)和高血压Ⅲ级组(n=30)。另选取同期体查的40例健康同龄人,作为健康组。依据24 h动态心电图获取心率变异性(HRV)评价交感神经活性,比较并分析不同组间受检者上述指标的差异。结果 EH合并LVH组最快心率、最慢心率、平均心率均高于EH组和对照组,全部正常窦性心搏间期的标准差(SDNN)、每5 min窦性心搏间期平均值的标准差(SDANN)、相邻窦性心搏间期差值的均方根(RMSSD)、相邻窦性心搏间期差值> 50 ms的心搏数百分比(p NN50)显著低于EH组和对照组,EH组心率和HRV各项指标也低于对照组,差异有统计学意义(P <0.05);高血压Ⅲ级组最快心率、LVH发生率均高于高血压Ⅰ级组,HRV各指标低于高血压Ⅰ级组,差异有统计学意义(P <0.05),高血压Ⅱ级组SDNN、SDANN、p NN50低于高血压Ⅰ级组,差异有统计学意义(P <0.05)。结论 EH合并LVH患者的交感神经活性明显增高,血压分级升高会加剧交感神经活性激活,增加LVH发生风险,重视加强HRV检查和抑制交感神经活性,有助于预防或逆转LVH。

Effect of essential hypertension with left ventricular hypertrophy on sympathetic nerve activity and its relationship with blood pressure classification

Objective To investigate the effect of essential hypertension(EH)combined with left ventricular hypertrophy(LVH)on sympathetic nerve activity and its relationship with blood pressure classification.Methods From January 2019 to June 2020,102 patients with EH admitted to the Affiliated Hospital of Guangdong Medical University were prospectively selected and divided into EH group(n=57)and EH combined with LVH group(n=45)according to echocardiography;according to the blood pressure measurement level and hypertension classification standard,they were divided into three groups:hypertension gradeⅠgroup(n=35),hypertension gradeⅡgroup(n=37)and hypertension gradeⅢgroup(n=30).In addition,40 healthy people of the same age were selected as the healthy group.Heart rate variability(HRV)was obtained from 24-hour holter to evaluate sympathetic nerve activity.The differences of the above indexes among different groups were compared and analyzed.Results The fastest heart rate,slowest heart rate and average heart rate in EH combined with LVH group were higher than those in EH group and control group,SDNN,SDANN,RMSSD and pNN50 were significantly lower than those in EH group and control group,heart rate and HRV indexes in EH group were also lower than those in control group,the differences were statistically significant(P<0.05);The incidence of the fastest heart rate and LVH in the hypertension groupⅢwas higher than that in the hypertension gradeⅠgroup,and the HRV indexes were lower than that in the hypertension gradeⅠgroup,the differences were statistically significant(P<0.05).The SDNN,SDANN and pNN50 of the hypertension gradeⅡgroup were lower than those of the hypertension gradeⅠgroup,the differences were statistically significant(P<0.05).Conclusion The sympathetic nerve activity of EH patients with LVH is significantly increased.The increase of blood pressure classification will aggravate the activation of sympathetic nerve activity and increase the risk of LVH.Strengthening HRV examination and inhibiting sympathetic activity are helpful to prevent or reverse LVH.