【摘要】 目的 探讨心电向量图(vectorcardiogram, VCG)早期诊断高血压心脏靶器官损害的意义，并分析不同程度高血压心脏靶器官损害的危险因素。方法 120例高血压患者均行心电图(electrocardiogram, ECG)、VCG及超声心动图(ultrasound cardiogram, UCG)检查，评估患者的心脏电活动变化及心脏结构变化，并比较ECG与VCG对高血压患者心脏电活动异常的检出情况；按VCG及UCG检查结果对高血压患者的心脏靶器官损害情况分为正常组(VCG、UCG均正常，n=40)、电重构组(VCG异常、UCG正常，n=40)及结构异常组(UCG异常，n=40),收集3组患者一般临床资料[年龄、性别、体质量、身高、体质量指数(body mass index, BMI)吸烟、饮酒、服药、作息、家族史及合并症等]、血生化指标及动态血压指标[包括24 h平均收缩压(24 h mean systolic blood pressure, 24 h SBP)、24 h平均舒张压(24 h mean diastolic blood pressure, 24 h DBP)、白昼平均收缩压(daytime average systolic blood pressure, DSBP)、白昼平均舒张压(daytime average diastolic blood pressure, DDBP)、夜间平均收缩压(nighttime average systolic blood pressure, NSBP)、夜间平均舒张压(nighttime average diastolic blood pressure, NDBP)、清晨SBP、清晨DBP、24 h SBP负荷、24 h DBP负荷、SBP变异性、DBP变异性、24 h脉压差(24 h mean pulse pressure, 24 h PP)、SBP节律及DBP节律],采用单因素及有序logistic回归分析不同程度高血压心脏靶器官损害的危险因素。结果 患者中VCG检出心脏电重构较ECG有优势(P<0.05);3组患者的性别、合并糖尿病、高血压病程、规律服药、家族史、血尿酸、24 h SBP、24 h DBP、DSBP、DDBP、 NSBP、NDBP、清晨SBP、清晨DBP、24 h SBP负荷、24 h DBP负荷及24 h PP等指标比较，差异有统计学意义(P<0.05);有序logistic回归分析结果显示，NSBP(OR=1.148,95%CI为1.068～1.232,P<0.001)、性别(OR=4.914,95%CI为1.872～12.897,P=0.001)及家族史(OR=4.707,95%CI为1.099～6.392,P=0.030)是心脏靶器官损害的危险因素。结论 VCG对高血压患者早期心脏靶器官电重构的检出较ECG具有优势，NSBP、性别及家族史是高血压心脏靶器官损害的危险因素。更多还原

【Abstract】 Objective To explore the early diagnostic significance of vector cardiogram(VCG) in hypertension-caused cardiac target organ damage and analyze the risk factors for different degrees of cardiac target organ damage in hypertension.Methods Electrocardiogram(ECG), VCG, and ultrasound cardiogram(UCG) were performed on 120 patients with hypertension. The patients were evaluated for the changes in cardiac electrical activity and cardiac structure, and compared for the detections of abnormal cardiac electrical activity in hypertensive patients between ECG and VCG. According to cardiac target organ damage in hypertensive patients based on VCG and UCG examination results, the patients with hypertension were divided into normal group(normal VCG and UCG, n=40), electrical remodeling group(abnormal VCG, normal UCG, n=40), and structural abnormality group(abnormal UCG, n=40). The patients in 3 groups were collected for general clinical data [age, gender, body mass, height, body mass index(BMI), smoking, alcohol consumption, medication, work and rest, family history, and comorbidities, etc.], blood biochemical indicators, and ambulatory blood pressure monitoring(ABPM) data [including 24 h mean systolic blood pressure(24 h SBP), 24 h mean diastolic blood pressure(24 h DBP), daytime average systolic blood pressure(DSBP), daytime average diastolic blood pressure(DDBP), nighttime average systolic blood pressure(NSBP), nighttime average diastolic blood pressure(NDBP), morning SBP, morning DBP, 24 h SBP load, SBP variability, DBP variability, 24 h mean pulse pressure(24 h PP), SBP rhythm, and DBP rhythm]. Univariate and ordered logistic regression analyses were performed to identify risk factors for various degrees of hypertensive cardiac target organ damage. Results VCG was superior to ECG in detecting cardiac electrical remodeling(P < 0.05). Among three groups, there were statistically significant differences in gender, comorbid diabetes, hypertension course, regular medication, family history, blood uric acid, 24 h SBP, 24 h DBP, DSBP, DDBP, NSBP, NDBP, morning SBP, morning DBP, 24 h SBP load, 24 h DBP load, and 24 h PP(P<0.05). Ordered logistic regression analysis revealed that NSBP(OR=1.148,95% CI was 1.068-1.232,P<0.001), gender(OR=4.914, 95% CI was 1.872-12.897, P=0.001) and family history(OR=4.707, 95% CI was1.099-6.392, P=0.030) were risk factors for cardiac target organ damage. Conclusion VCG has an advantage over ECG in detecting electrical remodeling in cardiac target organ at early stage in patients with hypertension.NSBP, gender and family history are risk factors for cardiac target organ damage in hypertension.更多还原