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目的探讨1、2级原发性高血压患者左室构型的改变及其与胰岛素抵抗的关系。方法选择江汉油田总医院高血压门诊及体检中心诊断的原发性高血压未行降压治疗的203例患者为研究对象。全部研究对象均行超声心动图检查及动态血压监测,查空腹血糖、血脂、尿酸及胰岛素,依超声心动图指标对左室构型进行分组,分为正常组、向心性重构组、向心性肥厚组及离心性肥厚组。结果 (1)各组间的空腹胰岛素以及胰岛素抵抗指数(HOMA-IR)差异有统计学意义(P<0.01),而年龄、性别、体质指数(BMI)、血压、空腹血糖及血脂等指标的差异无统计学意义(P>0.05)。(2)与正常组比较,向心性重构组的室间隔厚度、相对室壁厚度及总室壁厚度明显升高,差异均有统计学意义(P<0.05);向心性肥厚组超声心动图全部指标均明显升高,差异有统计学意义(P<0.05);离心性肥厚组左室舒张末期直径及左室质量指数明显升高,差异有统计学意义(P<0.05)。(3)相关分析表明,室间隔厚度、相对室壁厚度及总室壁厚度均与空腹胰岛素水平及HOMA-IR呈正相关,有统计学意义(P<0.01)。结论在未经降压治疗的1、2级高血压患者中,经超声心动图诊断左室构型异常的比例较高(65.12%)。在左室构型异常的诊断中,室间隔厚度及相对室壁厚度为早期指标,结合左室后壁厚度、左室质量指数及左室舒张末期直径可提高左室构型异常诊断的敏感性。对左室构型异常的患者应关注HOMA-IR的变化。
Objective To investigate the changes of left ventricular configuration and its relationship with insulin resistance in patients with grade 1,2 essential hypertension. Methods Totally 203 patients who were treated by hypertensive clinic and physical examination center in Jianghan Oilfield General Hospital were selected as the study objects. All the subjects underwent echocardiography and ambulatory blood pressure monitoring. The fasting blood glucose, blood lipids, uric acid and insulin were examined. The left ventricular configuration was divided into normal group, concentric remodeling group, concentric Hypertrophy group and eccentric hypertrophy group. Results (1) There were significant differences in fasting insulin and insulin resistance index (HOMA-IR) between the two groups (P <0.01), while age, gender, body mass index (BMI), blood pressure, fasting blood glucose, The difference was not statistically significant (P> 0.05). (2) Compared with the normal group, the ventricular remodeling thickness, relative wall thickness and total wall thickness were significantly increased (P <0.05); All parameters were significantly increased, the difference was statistically significant (P <0.05); left ventricular end diastolic diameter and left ventricular mass index increased significantly in eccentric hypertrophy group, the difference was statistically significant (P <0.05). (3) The correlation analysis showed that the thickness of ventricular septum, relative wall thickness and total wall thickness were positively correlated with fasting insulin level and HOMA-IR, with statistical significance (P <0.01). Conclusions Among the patients with grade 1 and 2 hypertension who did not receive antihypertensive treatment, the proportion of abnormal left ventricular configuration diagnosed by echocardiography was high (65.12%). In the diagnosis of abnormal left ventricular configuration, the thickness of the interventricular septum and relative wall thickness as an early indicator, combined with left ventricular posterior wall thickness, left ventricular mass index and left ventricular end-diastolic diameter can improve the sensitivity of left ventricular structural abnormalities diagnosis . Patients with abnormal left ventricular configuration should pay attention to changes in HOMA-IR.