【摘要】 目的　从整体水平探讨血流动力学、多种循环激素、细胞阳离子转运和环核苷酸在高血压左室肥厚 (LVH)发生中的作用。方法　采用 30例正常人和 45例高血压非LVH病人双重同期对照 ,观察 45例高血压LVH病人 (向心型 12例、离心型 33例 )的血压、外周阻力 (TPR) ,血浆 5种激素 ,淋巴细胞离子泵、阳离子和环核苷酸变化 ;并对左心室重量指数 (LVMI)与 2 2个相关预选因子进行逐步回归分析。结果　 (1)LVH病人收缩压和平均动脉压、血浆去甲肾上腺素 (NE)、内皮素 (ET)、血管紧张素Ⅱ (AngⅡ )、内源性洋地黄物质 (EDLS)和心钠素 (ANP)水平增高 ,细胞Na+ 、Ca2 + 、cAMP含量和cAMP/cGMP比值升高 ,细胞钠泵、钙泵活性、K+ 和Mg2 + 含量降低。 (2 ) 5种激素分别与离子泵、Na+ 、Ca2 + 和环核苷酸相关。 (3)LVMI与NE、ET、AngⅡ和EDLS ,钙泵、Na+ 、cAMP和cAMP/cGMP比值相关。 (4)LVMI与NE、ET、钙泵、Mg2 + 和cAMP之间有独立的相关关系。 (5 )向心型LVH病人TPR、AngⅡ高于离心型LVH病人 ,而K+ 低于离心型LVH病人。结论　血流动力学、循环激素、细胞离子转运和环核苷酸多个环节改变及其相互作用参与高血压LVH的发病过程 ,其中循环NE、ET ,细胞钙泵、Mg2 + 和cAMP可能起重要作用。TRP、AngⅡ和细胞K+ 可能与向心型LVH?更多还原

【Abstract】 Objective To investigate the possible roles of hemodynamics, circulating hormones, cell cation transport and cyclic nucleotides in left ventricular hypertrophy (LVH) of essential hypertension (EH) in vivo. Methods Blood pressure, total peripheral resistance (TPR) and plasma norepinephrine (NE), endothelin (ET), angiotensin Ⅱ (AngⅡ), endogenous digitalis like substances (EDLS) and atrial natriuretic peptide (ANP) were determined, along with the measurements of lymphocytic membrane ion pumps, cations and cyclic nucleotides in 45 EH patients with LVH (12 concentric hypertrophy, 33 eccentric hypertrophy), 30 normal subjects and 45 EH patients without LVH (as double concurrent controls). Multiple stepwise regression analysis was computed using left ventricular mass index (LVMI) as dependent variable and 22 parameters as independent variables. Results (1) In EH patients with LVH, increases were seen in systolic blood pressure, mean arterial pressure (MAP) and NE, ET, AngⅡ, EDLS and ANP as well as lymphocytic Na +, Ca 2+ , cAMP and cAMP/cGMP ratio, while Na + K + ATPase and Ca 2+ ATPase activities, K + and Mg 2+ decreased. (2) Five hormones were related respectively to ion pumps, Na +, Ca 2+ and cyclic nucleotides. (3) LVMI were correlated with NE, ET, AngⅡ and EDLS, Ca 2+ ATPase, Na +, cAMP and cAMP/cGMP ratio. (4) The regression equation revealed that NE, ET, Ca 2+ ATPase, Mg 2+ and cAMP were the independent factors affecting LVH. (5) TPR and AngⅡ were higher, K + was lower in concentric LVH than those in eccentric LVH. Conclusion The changes of hemodynamics, circulating hormones, cell cation transport and cyclic nucleotides, or their interaction may be involved in the pathogenesis of LVH in EH. NE, ET. Ca 2+ ATPase, Mg 2+ and cAMP seem to play more important parts in LVH . TPR , whereas AngⅡ and K + may relate to cocentric LVH.更多还原