上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (1): 69-.doi: 10.3969/j.issn.1674-8115.2012.01.013

• 论著（临床研究） • 上一篇    下一篇

高龄高血压患者心脏结构和功能的变化

胡 珺1, 朱 福1, 谢 骏1, 成兴海2, 陈桂雨2, 邰海凤3, 范少华3   

  1. 1.上海市徐汇区中心医院老年病科, 上海 200031； 2.南通大学医学院, 南通 226001； 3.江苏大学临床医学院, 镇江 212013
  • 出版日期:2012-01-28 发布日期:2012-01-29
  • 通讯作者: 朱 福, 电子信箱: zhufu@medmail.com.cn。
  • 作者简介:胡 珺（1970—）, 女, 副主任医师, 硕士；电子信箱: hujun0808@yahoo.cn。
  • 基金资助:

    上海市科委基金（10411968700）

Cardiac structure and function in senile patients with essential hypertension

HU Jun1, ZHU Fu1, XIE Jun1, CHENG Xing-hai2, CHEN Gui-yu2, TAI Hai-feng3, FAN Shao-hua3   

  1. 1.Department of Geriatrics, Shanghai Xuhui District Central Hospital, Shanghai 200031, China；2.Medical School of Nantong University, Nantong |226001, China；3.School of Clinical Medicine, Jiangsu University, Zhenjiang 212013, China
  • Online:2012-01-28 Published:2012-01-29
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 10411968700

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摘要：

目的 评价增龄和高血压对高龄高血压患者心脏结构和功能的影响。方法 收集150例老年住院患者，按年龄（≥80岁为高龄，60~80岁为老年）和高血压患病情况分为高龄高血压组（n=84）、高龄非高血压组（n=18）和老年高血压组（n=48）。记录患者的基本情况，检测血生化指标，并进行24 h动态血压监测。行心脏超声检查，检测和计算心脏的结构和功能指标；分析高血压患者病程与心脏结构和功能的相关性。结果 高龄高血压组患者的平均年龄、体质量指数、总胆固醇、高密度脂蛋白、低密度脂蛋白与老年高血压组比较，差异均有统计学意义（P<0.05或P<0.01）。高龄高血压组患者的24 h收缩压和舒张压均显著高于高龄非高血压组（P<0.01），两组患者的左心室质量、左心室质量指数和左心室后壁厚度比较差异也均有统计学意义（P<0.01）；但高龄高血压组的所有心脏结构指标与老年高血压组比较，差异均无统计学意义（P>0.05）。高龄高血压组患者的心脏功能指标与高龄非高血压组和老年高血压组比较，差异均有统计学意义（P<0.05）。相关分析显示，高血压病程与心脏结构指标均呈正相关（P<0.05或P<0.01），但与心脏功能指标均呈负相关（P<0.05）。结论 在高龄患者中，高血压导致更显著的左心室壁肥厚、心脏质量增加以及心脏收缩功能下降。随着高血压病程的延长，左心室肥厚、左心房和左心室扩大加剧，左心室收缩功能进一步下降，老年患者应在一定范围内平稳降压。

关键词: 高血压, 高龄, 左心室质量指数, 左心室肥厚, 左心室射血分数

Abstract:

Objective To investigate the effects of age and hypertension on cardiac structure and function in senile patients with essential hypertension. Methods One hundred and fifty hospitalized patients with essential hypertension were divided into senile hypertension group (n=84), senile non-hypertension group (n=18) and elderly hypertension group (n=48) according to age (senile, ≥80 years old; elderly, 60 to 80 years old) and conditions of hypertension. The baseline conditions were recorded, the blood biochemical parameters were measured, and 24 h ambulatory blood pressure monitoring was performed. Cardiac ultrasonography was conducted, and parameters of cardiac structure and function were measured and calculated. The correlation of disease course of hypertension with cardiac structure and function was analysed. Results There were significant differences in mean age, body mass index, total cholesterol, high-density lipoprotein and low-density lipoprotein between senile hypertension group and elderly hypertension group (P<0.05 or P<0.01). The 24 h systolic blood pressure and diastolic blood pressure in senile hypertension group were significantly higher than those in senile non-hypertension group (P<0.01), and there were significant differences in left ventricular mass, left ventricular mass index and left ventricular posterior wall thickness between these two groups (P<0.01), while there was no significant difference in parameters of cardiac structure between senile hypertension group and elderly hypertension group (P>0.05). The parameters of cardiac function in senile hypertension group were significantly different from those in elderly hypertension group and senile non-hypertension group (P<0.05). Correlation analysis revealed that the disease course of hypertension was positively related to the parameters of cardiac structure (P<0.05 or P<0.01), while was negatively related to the parameters of cardiac function (P<0.05). Conclusion In senile patients, hypertension may cause more serious left ventricular hypertrophy, increased cardiac mass and decreased cardiac systolic function. With the prolongation of disease course of hypertension, more severe left ventricular hypertrophy and left atrial and ventricular enlargement occur, and even serious left ventricular systolic function takes place. Decreasing blood pressure stably in a rational range is advisable for senile patients with essential hypertension.

Key words: hypertension, aging, left ventricular mass index, left ventricular hypertrophy, left ventricular ejection fraction