【摘要】 目的 应用二维斑点追踪技术评价左心室肥厚对老年高血压患者心肌力学的影响。方法 选取144例原发性老年高血压患者（高血压组），依据左室质量指数（LVMI）将老年高血压患者分为肥厚组（LVH组）和非肥厚组（NLVH组）。正常对照组（NC组）为48例既往无心脑血管疾病且年龄性别相匹配的老年人群。测量并比较各组一般临床资料，常规超声心动图参数，左心室整体纵向应变（GLS），基底段纵向应变（BLS），中段纵向应变（MLS），心尖段纵向应变（ALS）。以相关性分析及多元线性回归分析观察GLS影响因素。结果 从NC组、NLVH组到LVH组，GLS依次减小（P<0.05）。与NC组相比，NLVH组、LVH组的BLS、MLS均降低（P<0.05）,ALS无明显变化（P>0.05）。与NLVH组相比，LVH组BLS显著降低（P<0.05）,MLS、ALS无明显变化（P>0.05）。高血压组GLS与收缩压（SBP）、舒张压（DBP）、左心室舒张末期后壁厚度（LVPWD）、室间隔厚度（IVST）、体质指数（BMI）、相对室壁厚度（RWT）、LVMI、E/e’均呈负相关（r=-0.699、-0.220、-0.337、-0.340、-0.430、-0.293、-0.554、-0.408,P<0.001）。其中GLS与SBP、BMI、LVMI独立相关（P<0.05）。结论 与NC组相比，NLVH组与LVH组GLS均有不同程度受损，LVH组GLS受损最严重；与NC组相比，NLVH组与LVH组的BLS、MLS均受损；与NLVH组相比，LVH组BLS受损更严重；心肌肥厚对高血压患者心肌力学产生负面影响，高血压、肥胖、高LVMI水平是影响GLS值的重要因素。更多还原

【Abstract】 Objective To evaluate the influence of left ventricular hypertrophy(LVH) on myocardial mechanics in elderly patients with hypertension by applying two-dimensional speckle tracking imaging(2D-STI). Methods The elderly patients with primary hypertension(n=144) were selected into hypertension group, and according to left ventricular mass index(LVMI), they were divided into LVH group and non-LVH group(NLVH group). The elderly people with no previous cardiovascular and cerebrovascular diseases matching in age and sex were selected into normal control group(NC group). The general clinical data, conventional echocardiographic parameters, left ventricular longitudinal strain(GLS), basal longitudinal strain(BLS), middle longitudinal strain(MLS), and apical longitudinal strain(ALS) were detected and compared in all groups. The factors impacting GLS were observed by using correlation analysis and multiple linear regression analysis. Results GLS decreased in turn from NC group, NLVH group to LVH group(P<0.05). Compared with NC group, BLS and MLS decreased(P<0.05), and ALS had no significant change(P>0.05) in NLVH group and LVH group. Compared with NLVH group, BLS decreased significantly(P<0.05), and MLS and ALS had no significant change(P>0.05) in LVH group. In hypertension group, GLS was negatively correlated to systolic blood pressure(SBP), diastolic blood pressure(DBP), left ventricular posterior wall thickness at end diastole(LVPWD), interventricular septal thickness(IVST), body mass index(BMI), relative wall thickness(RWT), LVMI and E/e’(r=-0.699,-0.220,-0.337,-0.340,-0.430,-0.293,-0.554,-0.408, all P<0.001), and GLS was independently correlated to SBP, BMI and LVMI(P<0.05). Conclusion Compared with NC group, GLS was impaired in varying degrees in NLVH group and LVH group, which is the most severe in LVH group. Compared with NC group, BLS and MLS were impaired in NLVH group and LVH group, and BLS is impaired more severely in LVH group compared with NLVH group. Myocardial hypertrophy has a negative impact on myocardial mechanics in patients with hypertension, and hypertension, obesity high LVMI level are important factors affecting GLS value.更多还原