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目的 :探讨心电图ST T改变对估测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A、β和A·β值 ,并计算出A、β比值和冠状动脉微血管的血流储备 (CMVFR)。 结果 :与对照组相比 ,原发性高血压 (EH)伴ST T改变和无ST T改变患者静息时的A、β和A·β值均增高 ,尤以伴ST T改变者增高更明显 ;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CMVFR显著降低 ,其中ST T改变患者的 β值和CMVFR降低更明显 ;随着高血压病情的加重 ,A和A·β值增高 ,A值和CMVFR下降 ,A和A·β值与SBP、DBP显著正相关 (P <0 .0 1) ,CMVFR与DBP显著负相关 (P <0 .0 1) ;ST段改变与A比值 (r =0 .5 2 9,P <0 .0 1)和CMVFR(r =0 .4 11,P <0 .0 5 )显著相关。结论 :EH患者 ,尤其是伴ST T改变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 ;EH患者如果出现心电图ST T改变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 electrocardiogram ST T changes in estimating myocardial microvascular disease of hypertension. Methods: The myocardial contrast echocardiography (MCE) and intravenous microbubble contrast agent (perfluorinated) were used to measure the myocardial A, β and A · · values at rest and after dipyridamole injection by using interrupted harmonic imaging β value, and calculate the A, β ratio and coronary microvascular blood flow reserve (CMVFR). Results: Compared with the control group, the values of A, β and A · β increased at rest in patients with essential hypertension (EH) accompanied by ST T changes and without ST T changes, especially those with ST T changes Obviously; however, the increase amplitude of dipyridamole obviously decreased, the ratio of A, β and CMVFR decreased significantly, and the decrease of β value and CMVFR were more obvious in patients with ST T changes; with the worsening of hypertension, A and A Β value increased, A value and CMVFR decreased, A and A · β values had significant positive correlation with SBP and DBP (P <0.01), CMVFR had significant negative correlation with DBP (P <0.01) The changes were significantly correlated with the ratio of A (r = 0.529, P <0.01) and CMVFR (r = 0.41, P <0.05). CONCLUSIONS: Resting myocardial microcirculation increased blood flow in patients with EH, especially those with ST-T changes. Myocardial microvascular reserve function and non-endothelium-dependent vasodilator capacity were significantly impaired, myocardial capillary density was significantly reduced, and with disease Of the progress and aggravate; EH patients ECG STT changes should be considered if there is the possibility of myocardial microvascular disease; MCE for the diagnosis of hypertensive microvascular disease has a good prospect of application