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Title:: Left ventricular remodelling and its relation with insulin resistance and dyslipid in essential hypertensive patients based on ratio of observed/predicted left ventricular mass

作者:: 周裔忠¹; 2; 王洪¹; 祝善俊²; 于林君²; 李振魁²; 王江²; 田颖²; 1.江西省人民医院心内科，江西南昌 330006；2.第三军医大学新桥医院心内科，重庆 400037

Author(s):: ZHOU Yizhong; WANG Hong; ZHU Shanjun; YU Linjun; LI Zhenkui; WANG Jiang; TIAN Ying; 1.Department of Cardiology,Jiangxi Provincical People′s Hospital,Nanchang,Jiangxi 332006;2.Department of Cardiology, Xinqiao Hospital，Third Military Medical University, Chongqing 400037， China

关键词:: 左室质量百分比; 左室重构; 胰岛素抵抗; 高血压

Keywords:: ratio of observed/ predicted left ventricular mass; left ventricular remodeling; insulin resistance; hypertension

分类号:: R544.1

DOI:: -

文献标识码:: A

摘要:: 目的以左室质量百分比（%PLM）为基础，探讨原发性高血压（EH）患者左室重构与胰岛素抵抗、血脂异常的关系。方法 90例EH患者和60例正常对照者为研究对象，利用彩色多普勒分别记录舒张期室间隔厚度（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）、左室射血分数（LVEF）、左室短轴缩短率(FS)、每搏心输出量（SV），按照公式计算出体质量指数、左室质量实测值、左室质量预测值及%PLM，并测定空腹血糖（FBG）及空腹胰岛素（FINS），计算出胰岛素（IR， IR=FBG×FINS/22.5）。左室重构按%PLM将其分为左室质量适宜（73%～128%）、左室质量过高（>128%）、左室质量不足（<73%）等3型。分析3种类型的左室重构IR、血脂之间的关系。结果 ①左室质量适宜组、左室质量过高组、左室质量不足组3组的病程呈逐渐延长趋势，左室质量适宜组、左室质量过高组的LVEF、FS低于正常对照组，而左室质量不足组的LVEF、FS高于正常对照组（P<0.05）；②同正常组相比，EH组的FINS及IR值增高显著(P<0.01, 或P<0.05)，尤以左室质量过高组更为显著，其FINS、IR均高于左室质量适宜组、左室质量不足组；③同正常组相比，高血压组的TG、TC、LDL明显升高，HDL显著下降（P< 0.05,P< 0.01），进一步分析发现，左室质量不足组、左室质量过高组均存在血脂异常，尤以左室质量过高组为明显，而左室质量适宜组的血脂指标比正常对照组虽然升高，但无显著性差异。结论左室质量适宜、左室质量过高型EH的LVEF、FS均降低，而左室质量不足型EH的LVEF、FS均升高；左室质量适宜、左室质量过高、左室质量不足等3型EH均存在胰岛素抵抗，除左室质量适宜型外，其余二型均有血脂异常；胰岛素抵抗程度、血脂异常在左室质量过高型EH尤为突出。

Abstract:: AIM Using the ratio of observed/predicted left ventricular mass (%PLM) to explore the relation between the left ventricular remodelling and insulin resistance (IR) and dyslipid in patients with essential hypertension (EH). METHODS In 90 EH patients and 60 normal subjects, echocardiography were used to measure their IVSTD, LVPWTD, LVEDD, LVESD, LVEF, FS, SV and BMI. Left ventricular mass and predicted left ventricular mass were calculated. FPG and FINS were tested respectively. IR was expressed by FPG FINS/22.5 according to %PLM. left ventricular remodelling of the EH patients was divided into 3 types: adequate left mass (aLVM，%PLM: 73%~128%), inappropriately high left ventricular mass（ihLVM，%PLM>128%）and inadequate left mass（iaLVM，%PLM<73%）. RESULTS ① The course of disease of aLVM group was the longest, and that of iaLVM was the shortest. EF,FS were obviously declined in aLVM and ihLVM groups，but increased in iaLVM group;②Compared with control group, FINS and IR in EH patients obviously increased，especially in ihLVM group，much higher than in the other 2 groups. ③Compared with control group, TG, TC, LD, HDL, apoA1 in EH patients were all increased. CONCLUSION The increase of FINS,IR and dyslipidemia may occur in aLVM,ihLVM and iaLVM, with most obvious increase in the ihLVM.

参考文献/References

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［3］ de Simone G, Palieri V, koren MJ, et al. Prognostic implications of the compensatory nature of left ventricular mass in arterial hypertension［J］. J Hypertens,2001,19;119-125.

［4］文丹, 黄磊, 姜德谦. 左室质量指数和左室质量百分比对高血压左室重塑识别的比较［J］. 高血压杂志, 2003,11（1）：47-50.

［5］Allayee H，de Bruin TWA，Michelle Dominguez K，et al. Genome scan for blood pressure in dutch dyslipidemic famaillies reveals linkage to locus on chromosome 4p［J］. Hypertension，2001，38（4）;773-778.

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