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目的研究用最大弹性膜量(Emax)评价原发性高血压(EH)左室重构的生物力学特性及其临床意义。方法研究对象为96例EH患者(EH组)和30例健康人(正常对照组)。应用超声心动图测定左室收缩及舒张末期内径、左室收缩末期容量、重量指数(LVMI)和相对室壁厚度(RWT)、射血分数(EF)、短轴缩短率(FS)。根据LVMI和RWT将EH患者分为左室正常构型亚组、向心性重构亚组、向心性肥厚亚组、离心性肥厚亚组。应用上述各测值计算最大弹性膜量(Emax)。结果①EF、FS正常对照组分别为(62.74±1.04)%、(34.13±0.78)%,高血压正常构型亚组为(62.24±1.31)%、(33.71±1.96)%,向心性重构亚组为(64.29±1.26)%、(34.96±0.93)%,向心性肥厚亚组为(63.44±1.29)%、(34.69±0.97)%,离心性肥厚亚组为(60.13±2.08)%、(32.68±1.45)%;以EF、FS表示的心脏收缩功能在正常对照组与EH各亚组间、EH各亚组间差异无统计学意义(P>0.05)。②Emax正常对照组为(0.209±0.0014)mmHg/ml,高血压正常构型亚组为(0.520±0.0075)mmHg/ml,向心性重构亚组为(0.697±0.0084)mmHg/ml,向心性肥厚亚组为(0.827±0.0155)mmHg/ml,离心性肥厚亚组为(0.771±0.0129)mmHg/ml。Emax在EH组呈现增高的趋势;在正常对照组与EH各亚组间差异有统计学意义(P<0.01);EH各亚组间Emax差异亦具统计学意义(P<0.01)。结论应用超声心动图无创测定心功能力学参数Emax对EH左室重构心肌生物力学特性的评价具有特殊的诊断价值。
Objective To investigate the biomechanical properties and clinical significance of left ventricular remodeling in patients with essential hypertension (EH) using maximum elastic membrane volume (Emax). Methods The subjects were 96 EH patients (EH group) and 30 healthy people (normal control group). Left ventricular systolic and diastolic diameters, left ventricular end systolic volume, weight index (LVMI) and relative wall thickness (RWT), ejection fraction (EF) and short axis shortening (FS) were measured by echocardiography. According to LVMI and RWT, EH patients were divided into normal subgroup of left ventricle, concentric reconstruction subgroup, concentric hypertrophy subgroup and eccentric hypertrophy subgroup. The maximum elastic film amount (Emax) was calculated using each of the above measurements. Results ① The normal control group of EF and FS were (62.74 ± 1.04)% and (34.13 ± 0.78)%, respectively. The normal hypertensive subgroup was (62.24 ± 1.31)% and (33.71 ± 1.96)%, respectively. (64.29 ± 1.26)% and (34.96 ± 0.93)% respectively in the group of centripetal hypertrophy were (63.44 ± 1.29)% and (34.69 ± 0.97)%, respectively, and (60.13 ± 2.08)% and 32.68 ± 1.45)% respectively. There was no significant difference in the systolic function between EF and FS in the subgroups of EH and normal controls (P> 0.05). (2) The normal control group of Emax was (0.209 ± 0.0014) mmHg / ml, the normal hypertensive subgroup was (0.520 ± 0.0075) mmHg / ml and the concentric remodeling subgroup was (0.697 ± 0.0084) mmHg / ml, The subgroup was (0.827 ± 0.0155) mmHg / ml, and the eccentric hypertrophy subgroup was (0.771 ± 0.0129) mmHg / ml. Emax showed a trend of increase in EH group. There was significant difference between normal control group and EH subgroup (P <0.01). Emax difference between EH subgroups was also statistically significant (P <0.01). Conclusion The application of echocardiography in noninvasive measurement of cardiac function parameter Emax has a special diagnostic value in evaluating the biomechanical properties of left ventricular remodeling in EH.