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背景心房颤动(AF)是最常见的心律失常,原发性高血压(EH)在人群中的发病率较高,使之成为与AF相关的最常见的疾病。因而预测EH病人发生AF的危险因素在临床上具有实用性,而有关原发高血压伴心房颤动(EH+AF)病人左心重塑特点的研究较少。目的研究EH+AF患者左心重构及其功能特点、临床意义,对EH患者发生AF的危险因素作初步探讨。方法入选EH+AF组224例(男120例,女104例),EH组171例(男97例,女74例),单纯心房颤动组(AF组)166例(男90例,女76例),对照组为年龄和性别匹配的健康体检者157例(男93例,女64例)。采用超声心动图检测舒张末期室间隔厚度(IVSTd)、舒张末期左室后壁厚度(LVPWTd)、舒张末期左室内径(LVEDD)、收缩末期左室内径(LVESD)、左房内径(LAD)、左室射血分数(LVEF)、每搏输出量(SV)、心排血量(CO),计算左室质量(LVM)、左室质量指数(LVMI)及左室壁相对厚度(RWT)。结果EH组与EH+AF组的收缩压、舒张压明显高于对照组和AF组(P<0.05)。4组间IVSTd、LVPWTd、LVESD、LVEDD、LAD、RWT值均以EH+AF组最大,与其他3组差异均有统计学意义(P<0.05),而EH及AF两因素对LVESD、LAD及RWT均具有交互效应(P<0.05)。4组间LVM、LVMI值均以EH+AF组最大,EH+AF组的LVEF和左室短轴缩短率(FS)值明显低于其他3组(P<0.05),EH及AF对LVM、LVMI、FS及LVEF值具有交互效应(P<0.05)。结论EH或AF发生时,患者的左心结构及功能亦发生改变,EH+AF时这种变化则更为显著。
Background Atrial fibrillation (AF) is the most common arrhythmia and the high prevalence of essential hypertension (EH) among the population makes it the most common disease associated with AF. Therefore, it is clinically feasible to predict the risk factors of AF in EH patients. However, there are few studies on the characteristics of left heart remodeling in patients with essential hypertension with atrial fibrillation (EH + AF). Objective To study the left ventricular remodeling, its functional characteristics and clinical significance in patients with EH and AF and to explore the risk factors of AF in patients with EH. Methods A total of 224 patients (120 males and 104 females) were enrolled in the EH + AF group, 171 in the EH group (97 males and 74 females) and 166 patients (90 males and 76 females) in the atrial fibrillation group (AF group) ). The control group consisted of 157 healthy subjects (93 males and 64 females) matched for age and gender. The left ventricular diameter (LVST), diastolic left ventricular posterior wall thickness (LVPWTd), left ventricular end diastolic dimension (LVEDD), end systolic left ventricular diameter (LVESD) Left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), left ventricular mass (LVM), left ventricular mass index (LVMI) and left ventricular wall thickness (RWT) were calculated. Results The systolic and diastolic blood pressures in EH group and EH + AF group were significantly higher than those in control group and AF group (P <0.05). The values of IVSTd, LVPWTd, LVESD, LVEDD, LAD and RWT in the four groups were the highest in EH + AF group and the other three groups were statistically significant (P <0.05) RWT had interactive effects (P <0.05). LVM and LVMI values of the four groups were the largest in EH + AF group, LVEF and left ventricular short axis shortening (FS) values in EH + AF group were significantly lower than those in the other three groups (P <0.05) LVMI, FS and LVEF values had an interactive effect (P <0.05). Conclusions The left ventricular structure and function of patients also changed when EH or AF occurred. This change was more obvious at EH + AF.