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目的评估原发性高血压患者左心室收缩功能和血浆脂联素水平的关系。方法入选2015年3月至2015年10月门诊收治的原发性高血压患者203例,根据排除标准最终纳入单纯高血压患者160例。根据左心室质量指数(LVMI)>125(男性)或>120g/m2(女性),将高血压患者分为无左心室肥厚(LVH)组[LVH(-),n=80]与左心室肥厚组[LVH(+),n=80]。对照组是从医院健康体检人群中抽取,包括年龄、性别和体质量指数(BMI)匹配的正常血压健康自愿者(n=82)。采用二维斑点追踪超声心动图(2D-STE)分别评估各组受试者的左心室收缩功能指标[左心室长轴应力(LVLS)、左心室环向应力(LVCS)和左心室径向应力(LVRS)];应用酶联免疫吸附分析法(ELISA)测定血浆脂联素水平。观察和分析各组受试者血浆脂联素水平的差异及其与左心室收缩功能的关系。结果高血压患者收缩压和舒张压高于对照组,脂联素水平低于对照组(均P<0.05);在高血压患者中,LVH患者脂联素水平下降更明显(P<0.05)。LVH(+)组左心房内径(LAD)、左心室舒张末期内径(LVEDD)高于对照组和LVH(-)组(均P<0.05)。LVH(+)组和LVH(-)组室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、相对室壁厚度(RWT)和左心室质量指数(LVMI)高于对照组,且LVH(+)组高于LVH(-)组(均P<0.05)。与对照组相比,LVLS在LVH(-)组患者中明显降低[-(17.9±2.0)%比-(21.4±2.3)%,P<0.05],在LVH(+)组患者中,LVLS进一步降低[-(15.3±1.8)%,P<0.05]。相关分析显示,LAD、RWT和LVMI与血浆脂联素水平呈负相关(分别:r=-0.339、r=-0.377、r=-0.415;均P<0.05)。血浆脂联素水平与LVLS呈正相关(r=0.469,P<0.01)。多因素逐步回归分析显示,血浆脂联素水平(β=0.278,P<0.05)和LVMI(β=0.468,P<0.05)是LVLS的影响因素。结论血浆脂联素水平降低可能与高血压患者左心室纵向收缩功能受损相关联。
Objective To evaluate the relationship between left ventricular systolic function and plasma adiponectin levels in patients with essential hypertension. Methods Totally 203 patients with essential hypertension admitted to our clinic from March 2015 to October 2015 were enrolled and 160 patients with simple hypertension were finally included according to the exclusion criteria. Hypertensive patients were divided into two groups according to left ventricular mass index (LVMI)> 125 (male) or> 120g / m2 (female) Group [LVH (+), n = 80]. Control subjects were normotensive healthy volunteers (n = 82) drawn from hospital health checkups and matched for age, gender, and body mass index (BMI). Left ventricular systolic function (left ventricular long-axis stress (LVLS), left ventricular circumferential stress (LVCS) and left ventricular radial stress (LVCS) were assessed by two-dimensional speckle tracking echocardiography (2D-STE) (LVRS)]; plasma adiponectin levels were measured by enzyme-linked immunosorbent assay (ELISA). Observe and analyze the differences of plasma adiponectin levels and the relationship between the left ventricular systolic function and the subjects’ Results Compared with the control group, the systolic and diastolic blood pressure of hypertensive patients were higher than that of the control group (all P <0.05). The levels of adiponectin in hypertensive patients were more significantly decreased (P <0.05). Left atrial diameter (LAD) and left ventricular end diastolic diameter (LVEDD) in LVH (+) group were significantly higher than those in control group and LVH group (all P <0.05). IVST, LVPWT, RWT and LVMI in LVH (+) and LVH (-) groups were higher than those in control group, and LVH ( +) Group was higher than LVH (-) group (all P <0.05). Compared with the control group, LVLS was significantly decreased in patients with LVH (-) [- (17.9 ± 2.0)% vs (21.4 ± 2.3)%, P <0.05] Decreased [- (15.3 ± 1.8)%, P <0.05]. Correlation analysis showed that LAD, RWT and LVMI were negatively correlated with plasma adiponectin levels (r = -0.339, r = -0.377, r = -0.415; all P <0.05). Plasma adiponectin levels were positively correlated with LVLS (r = 0.469, P <0.01). Multi-factor stepwise regression analysis showed that plasma adiponectin levels (β = 0.278, P <0.05) and LVMI (β = 0.468, P <0.05) were the influencing factors of LVLS. Conclusions The decrease of plasma adiponectin levels may be related to the longitudinal systolic left ventricular dysfunction in hypertensive patients.