实用临床医药杂志2025，Vol.29Issue(11)：61-66,6.DOI:10.7619/jcmp.20250477
原发性高血压患者心脏微循环灌注受损、左心室重构及心肌纤维化的临床研究
Clinical research on impaired cardiac microcirculatory perfusion,left ventricular remodeling and myocardial fibrosis in patients with essential hypertension
摘要
Abstract
Objective To explore the situation of impaired cardiac microcirculatory perfusion,left ventricular remodeling and myocardial fibrosis in patients with essential hypertension(abbreviated as hypertension)and their clinical significance.Methods Eighty patients with hypertension were selected as hypertension group,and another 80 healthy individuals who underwent physical examina-tions during the same period were selected as control group.Based on the severity of hypertension,patients in the hypertension group were divided into low-risk group and moderate-to-high-risk group.The indicators of impaired cardiac microcirculatory perfusion[left ventricular myocardial blood flow(MBF),right ventricular MBF,coronary flowreserve(CFR)],left ventricular remodeling[left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)]and myocardial fibrosis[left ventricular isovolumic relaxation time(IVRT),the ratio of the peak velocity of E wave to A wave in the diastolic blood flow spectrum of the mitral valve orifice(E/A),type Ⅰ procollagen carboxy-terminal peptide(P Ⅰ CP),type Ⅲprocollagen amino-terminal peptide(PC Ⅲ)]were compared between the control group and the hy-pertension group.Pearson's correlation coefficient method was used for correlation analysis.The differences in the above-mentioned indicators among different risk groups were compared.Receiver operating characteristic(ROC)curves were drawn to evaluate the diagnostic efficacy of impaired cardiac microcirculatory perfusion,left ventricular remodeling and myocardial fibrosis for the severity of hypertension.Results In the hypertension group,left ventricular MBF,right ventricular MBF and CFR were all lower than those in the control group,LVEDV and LVESV were larger than those in the control group,LVEF was lower than that in the control group,IVRT was longer than that in the control group,the levels of P Ⅰ CP and PC Ⅲ were higher than those in the control group,and E/A was lower than that in the control group(P＜0.05).The results of Pearson's correlation coef-ficient analysis showed that LVEF was positively correlated with CFR and E/A,and negatively cor-related with IVRT and PC Ⅲ;LVEDV was positively correlated with CFR,IVRT,P Ⅰ CP and PCⅢ;LVESV was positively correlated with IVRT,P Ⅰ CP and PC Ⅲ,and negatively correlated with E/A;left ventricular MBF was positively correlated with CFR and E/A,and negatively correlated with IVRT,P Ⅰ CP and PC Ⅲ;right ventricular MBF was positively correlated with CFR and E/A,and negatively correlated with IVRT,P Ⅰ CP and PC Ⅲ.In the moderate-to-high-risk group,IVRT was longer than that in the low-risk group,LVEDV was larger than that in the low-risk group,P ⅠCP,PC Ⅲ,E/A,LVEF,left ventricular MBF,right ventricular MBF and CFR were all lower than those in the low-risk group,and LVESV was smaller than that in the low-risk group,with statistical-ly significant differences(P＜0.05).The results of ROC curve analysis showed that the areas under the curves for diagnosing the severity of hypertension by impaired cardiac microcirculatory perfusion,left ventricular remodeling and myocardial fibrosis were 0.962,0.969 and 0.945 respectively,the sensitivities were 91.4％,97.1％and 88.6％respectively,and the specificities were 95.6％,88.9％and 93.3％respectively.Conclusion Hypertension can cause impaired cardiac microcirculatory perfusion and promote the processes of left ventricular remodeling and myocardial fibrosis.Impaired cardiac microcirculatory perfusion,left ventricular remodeling and myocardial fibrosis have good di-agnostic efficacy for the severity of hypertension.关键词
原发性高血压/心脏微循环灌注受损/左心室重构/心肌纤维化/冠状动脉血流储备/心肌血流量/Ⅰ型前胶原羧基端肽/Ⅲ型前胶原氨基端肽Key words
essential hypertension/impaired cardiac microcirculatory perfusion/left ventric-ular remodeling/myocardial fibrosis/coronary flow reserve/myocardial blood flow/type Ⅰ procol-lagen carboxy-terminal peptide/type Ⅲ procollagen amino-terminal peptide分类
医药卫生引用本文复制引用
翟小菊,柴贞,王贤胜,高雄一..原发性高血压患者心脏微循环灌注受损、左心室重构及心肌纤维化的临床研究[J].实用临床医药杂志,2025,29(11):61-66,6.基金项目
河南省医学科技攻关计划项目(LHGJ20230414) （LHGJ20230414）
