本文選題：高血壓 + 血同型半胱氨酸��； 參考：《天津醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:應(yīng)用超聲心動圖技術(shù)綜合評價H型高血壓患者的左室舒張功能,并對其可能的臨床價值進行初步探討。方法:選取2014年4月至2015年2月天津醫(yī)科大學(xué)第二醫(yī)院住院且確診為原發(fā)性高血壓的患者159例,依據(jù)血同型半胱氨酸(HCY)水平將其分為HCY10μmol/L組即非H高血壓組(A組)54例和HCY≥10μmol/L組即H型高血壓組(B組)105例。另選取24例血壓正常、心電圖及胸片等常規(guī)檢查無異常者作為對照組(N組)。應(yīng)用Philips iE33型彩色心臟超聲診斷儀,配有QLAB 3DQ Advanced定量分析軟件程序,X5-1探頭,探頭頻率1.0-5.0MHz。二維超聲檢測室間隔厚度(IVST)、左室后壁厚度(LVPWT)、左室舒張末內(nèi)徑(LVDd)、左室收縮末內(nèi)徑(LVDs)、左房內(nèi)徑(LAD),Simpson法檢測左室射血分數(shù)(LVEF)。脈沖多普勒檢測二尖瓣血流頻譜舒張早期E峰峰值、舒張晚期A峰峰值及E峰減速時間(DT),并計算E/A,獲取右上肺靜脈收縮期峰值流速(PVS)、舒張早期峰值流速(PVD)、舒張晚期峰值流速(PVA),并計算S/D。組織多普勒(TDI)檢測二尖瓣環(huán)頻譜舒張早期Em峰峰值、舒張晚期Am峰峰值及等容舒張時間(IRT),計算E/Em、Em/Am,并根據(jù)公式Tei=a-b/a計算Tei指數(shù)。彩色M型超聲(CMD)檢測左室內(nèi)血流傳播速度(Vp)。實時三維全容積法測量左房容積(LAV),并根據(jù)公式LAVI=LAV/BSA計算左房容積指數(shù)(LAVI)。所有入選患者記錄身高、體重、吸煙史、飲酒史、計算體表面積(BSA);測量血壓、血糖、血脂及血HCY等指標(biāo)。結(jié)果:1.B組HCY明顯高于N組及A組(P0.05),A、B組收縮壓及甘油三酯明顯高于N組(P0.05),A組TC高于N組及B組(P0.05),余組間一般資料及生化指標(biāo)未見統(tǒng)計學(xué)差異(P0.05)。2.三組常規(guī)超聲結(jié)構(gòu)測值LAD、LVDs、LVDd、IVST、LVPWT及收縮功能指標(biāo)LVEF無統(tǒng)計學(xué)差異(P0.05)。3.與n組相比,a組與b組em/am及e/a明顯減低,e/em明顯增高(p0.05);與a組相比,b組em/am更低而e/em更高(p0.05);a、b組間e/a無顯著差別(p0.05)。b組irt明顯高于n組而s/d明顯低于n組(p0.05),a、n組間未見顯著差別(p0.05)。dt在三組間未見顯著差異(p0.05)。4.a組、b組tei指數(shù)及l(fā)avi較n組明顯增高(p0.05),且b組tei指數(shù)及l(fā)avi明顯高于a組(p0.05)。a組、b組vp較n組明顯減低(p0.05),且b組vp明顯低于a組(p0.05)。5.a、b組tei指數(shù)與em/am呈顯著負相關(guān)(p0.05);與e/em呈顯著正相關(guān)(p0.05);與e/a未見相關(guān)關(guān)系(p0.05)。6.a、b組患者vp與e/em呈顯著負相關(guān)(p0.05);與em/am呈顯著正相關(guān)(p0.05),與e/a未見相關(guān)關(guān)系(p0.05)。7.a、b組lavi與e/em呈顯著正相關(guān)(p0.05);與em/am及e/a呈顯著負相關(guān)(p0.05)。8.tei指數(shù)與vp呈負相關(guān)(r=-0.432,p0.01)、與lavi呈正相關(guān)(r=0.336,p0.05);vp與lavi呈負相關(guān)(r=-0.300,p0.05)。9.a、b組hcy與em/am、vp呈負相關(guān)(p0.05);與收縮壓、e/em、lavi及tei指數(shù)呈正相關(guān)(p0.05),其中與e/em、lavi、vp及tei指數(shù)的相關(guān)系數(shù)較高,分別為0.839、0.666、-0.548及0.519;hcy與高血壓病程、年齡、舒張壓水平、lvef、e/a無明顯相關(guān)(p0.05)。結(jié)論:1.高血壓患者左室舒張功能改變較心臟結(jié)構(gòu)及收縮功能改變出現(xiàn)更早且明顯。2.h型高血壓患者左室舒張功能障礙更為明顯,且hhcy與多項舒張功能指標(biāo)顯著相關(guān),提示舒張功能改變可能與hhcy有一定關(guān)系。3.左房容積指數(shù)更能確切反映左房大小,可作為較左房內(nèi)徑更佳的左房結(jié)構(gòu)指標(biāo)。4.tei指數(shù)、vp及l(fā)avi與傳統(tǒng)的超聲指標(biāo)存在良好相關(guān),且在檢測舒張功能時不存在假性正�；�,可更廣泛的應(yīng)用于臨床評價左室舒張功能。5.積極治療h型高血壓,可否延緩高血壓患者左室舒張功能障礙的發(fā)生及進展尚需進一步研究。
[Abstract]:Objective: To evaluate the left ventricular diastolic function of patients with type H hypertension by echocardiography, and to discuss its possible clinical value. Methods: 159 patients hospitalized in Second Hospital Affiliated to Tianjin Medical University from April 2014 to February 2015 were diagnosed as essential hypertension, and the level of blood homocysteine (HCY) was based on the level of blood homocysteine (HCY). It was divided into group HCY10 mu mol/L, that is, 54 cases of non H hypertension group (group A) and 105 cases of H type hypertension group (group B) with HCY more than 10 mu mol/L group (B group). Besides, 24 cases of normal blood pressure, electrocardiogram and chest X-ray examination were selected as control group (N group). The Philips iE33 color echocardiography was used. 5-1 probes, probe frequency 1.0-5.0MHz. two-dimensional ultrasound examination interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic diameter (LVDd), left ventricular end systolic diameter (LVDs), left atrium diameter (LAD), Simpson method to detect left ventricular ejection fraction (LVEF). Pulse Doppler detection of the early diastolic peak peak of diastolic peak, late diastolic A peak peak Value and E peak deceleration time (DT), and calculate E/A, obtain the peak systolic peak velocity (PVS), early diastolic peak velocity (PVD), late diastolic peak velocity (PVA), and calculate the peak value of the early diastolic peak, the peak value of the late diastolic Am peak and the equal volume diastolic time (IRT) of the S/D. tissue Doppler (TDI), and calculate the E/Em. The Tei index was calculated by the formula Tei=a-b/a. The left chamber flow velocity (Vp) was measured by color M ultrasound (CMD). The left atrial volume (LAV) was measured in real time three-dimensional full volume method (LAV), and the left chamber volume index (LAVI) was calculated according to formula LAVI=LAV/BSA. All selected patients recorded height, weight, smoking history, drinking history, and calculated body surface area (BSA), and measured blood pressure, Results: the HCY in group 1.B was significantly higher than that of group N and A group (P0.05). The systolic pressure and triglyceride in group of A and B were significantly higher than that of group N (P0.05), and A group TC was higher than that of group N (P0.05), and there was no statistical difference between the general and biochemical indexes of the remaining three groups. Compared with group n, em/am and e/a in a group and B group were significantly lower and e/em significantly increased (P0.05) than that of group n (P0.05). There was no significant difference between group A and a group (P0.05) in a group and B group (P0.05). There was no significant difference (P0.05) in group.4.a, and the Tei index and Lavi in group B were significantly higher than those in N group (P0.05), and the Tei index and Lavi of B group were significantly higher than those of a group (P0.05). There was a significant negative correlation between VP and e/em (P0.05) in group B (P0.05); there was a significant positive correlation with em/am (P0.05), and no correlation with e/a (P0.05).7.a, and there was a significant positive correlation between the B group and the e/a (P0.05). VP and Lavi were negatively correlated (r=-0.300, P0.05).9.a, B group Hcy and em/am, VP showed negative correlation (P0.05), and had a positive correlation with systolic pressure, e/em, Lavi, and index index. 5) conclusion: 1. the changes of left ventricular diastolic function in patients with hypertension were earlier than those of cardiac structure and systolic function, and left ventricular diastolic dysfunction in patients with type.2.h hypertension was more obvious, and HHcy was significantly related to multiple diastolic function indicators, suggesting that the diastolic function may be more accurate in relation to the.3. left atrial volume index (HHcy). The size of the left atrium can be used as an index of the left atrial structure that is better than that of the left atrium. VP and Lavi have a good correlation with the traditional ultrasound indicators, and there is no pseudonormalization in the detection of diastolic function. It is more widely used in the clinical evaluation of the left ventricular diastolic function of.5. accumulation in the treatment of H type hypertension, and may delay the hypertension patients. The occurrence and progress of left ventricular diastolic dysfunction need further study.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R544.1

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本文編號：2051541