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目的探讨超声心动图诊断左室肥厚(LVH)对评价高血压心肌微血管病变的价值。方法应用心肌对比超声心动图(MCE),静注微泡造影剂(全氟显)后,采用间断谐波成像技术测量静息时和注射双嘧达莫后心肌的最大微泡数量(A)、充填速度(β)和A·β值,并计算出A、β比值和冠脉微血管的血流储备(CFVR)。结果与对照组相比,高血压伴LVH和无LVH患者静息时的A、β和A·β值均增高,尤以伴LVH者增高更明显;而应用双嘧达莫后它们增加的幅度明显减少,A、β比值以及CFVR显著降低,LVH患者降低更明显;A和A·β与LVM和LVMI显著相关(P<0.01)。随着高血压病情的加重,A和A·β值增高,A比值和CFVR下降,A和A·β值与收缩压(SBP)、舒张压(DBP)显著正相关(P<0.01),CFVR与DBP显著负相关(P<0.01)。结论高血压患者,尤其是伴LVH患者的静息心肌微循环血流量增加、心肌微血管储备功能和非内皮依赖性的血管扩张能力明显受损、心肌毛细血管密度明显减少,并且随着疾病的进展而加重;高血压患者如果合并LVH时应考虑存在心肌微血管病变的可能性;MCE对诊断高血压微血管疾病有着良好的应用前景。
Objective To investigate the value of echocardiography in the diagnosis of left ventricular hypertrophy (LVH) in the assessment of myocardial microangiopathy in hypertensive patients. Methods After myocardial contrast echocardiography (MCE) and intravenous injection of microbubble contrast agent (perfluorinated), the maximum number of microvesicles of myocardium at rest and after injection of dipyridamole was measured by discontinuous harmonic imaging (A) , Filling velocity (β) and A · β, and calculate the A, β ratio and coronary microvascular blood flow reserve (CFVR). Results Compared with the control group, the values of A, β and A · β increased at rest in hypertensive patients with LVH and without LVH, especially those with LVH. However, their increasing amplitude after application of dipyridamole A / β ratio and CFVR decreased significantly, LVH patients decreased more obviously; A and A · β were significantly correlated with LVM and LVMI (P <0.01). With the aggravation of hypertension, A and A · β increased, A decreased and CFVR decreased, and A and A · β had significant positive correlation with SBP and DBP (P <0.01). CFVR Negatively correlated with DBP (P <0.01). Conclusions Hypertension, especially in patients with LVH, increased myocardial microcirculation blood flow, myocardial microvascular reserve function and non-endothelium-dependent vasodilation was significantly impaired, myocardial capillary density was significantly reduced, and as the disease progressed And aggravate; hypertensive patients with LVH should consider the possibility of myocardial microvascular disease; MCE for the diagnosis of hypertensive microvascular disease has a good prospect.