目的 研究老年高血压患者随诊间收缩压变异性与舒张性心力衰竭的关系.方法 收集2010年7月-2012年7月在郑州大学第一附属医院老年心内科门诊随诊的40例老年高血压患者的随诊血压,随诊末期行彩超检查患者的室间隔厚度(VS)、左室舒张末期容积(LVDd)、左室收缩末期容积(LVDs)、左心室后部厚度(PW)、舒张早期左房室血流速度(E)、舒张早期左房室瓣环运动速度(E′)、颈动脉内膜中层厚度(IMT),检测患者的血清脑钠肽(BNP)水平,计算左室质量指数(LVMI),以随诊间收缩压标准差(SD)作为收缩压变异性的指标,E/E′作为左室舒张功能的指标.结果 随诊间SD为(9±4)mm Hg,SD与E/E′、LVMI、IMT呈正相关(r=0.389、0.318、0.512,P＜0.05);BNP与E/E′呈负相关(r=-0.869,P＜0.05),与LVMI、IMT呈正相关(r=0.582、0.488,P＜0.05).多元线性回归分析显示,SD和BNP对E/E′的影响有统计学意义(P＜0.05).结论 随诊间收缩压变异性是老年高血压患者舒张性心力衰竭的独立危险因素,可以预测患者舒张性心力衰竭的发生.%Objective To analyze the relationship of visit - to - visit variability in systolic blood pressure ( SBP ) with diastolic heart failure ( DHF ). Methods The follow - up blood pressure ( BP ) of 40 elderly hypertensive patients visiting department of cardiology of this hospital from July 2010 to July 2012 were observed and at the end of follow - ups ventricular septal thickness, left ventricular end - diastolic volume, left ventricular end - systolic volume, left ventricular posterior wall thickness, early diastolic mitral flow velocity ( E ), early diastolic mitral annular velocity ( E' ), carotid intima - media thickness ( IMT ) were determined by color Doppler ultrasound, and serum brain natriuretic peptide ( BNP ) detected, follow - up SBP variation and left ventricular mass index ( LVMI) and E/E' calculated. Taking follow - up SBP standard deviation ( SD ) as BPV indicator, E/E' represented left ventricular diastolic ( LVD ) function. Results The follow - up SBP SD was ( 9 ±4 ) mm Hg, positively correlated with E/E', LVMI, IMT(r= 0.389、 0. 318、 0.512, P<0. 05), BNP negatively with E/E' (r= -0.869, P < 0. 05 ), positively with LVMI, IMT ( r = 0. 582 、 0. 488 , P < 0. 05 ). Multiple linear regression analysis showed that SD and BNP have significant impact on the E/E' ( P < 0. 05 ). Conclusion Follow - up BPV, related to LVD function and independent risk factors of DHF in elderly hypertension patients, can both predict occurrence of DHF.
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