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目的:评价踝臂脉搏波传导速度(baPWV)对高血压患者早期轻度舒张功能不全(DHF)的诊断价值。方法:根据诊断标准,选择高血压伴轻度左室DHF患者40例(HT-DHF组)和与其年龄匹配的健康人群32例(对照组),以及有高血压但无DHF患者44例(HT组)。测量所有研究对象的baPWV,同时测定体质指数(BMI)、脉压(PP)、脑钠肽(BNP)和心脏超声指标。结果:HT-DHF组有血脂异常、糖尿病患者的数量及BMI与HT组比较,均差异有统计学意义(均P<0.05)。HT-DHF组baPWV、PP、左室重量指数(LVMI)、BNP、左房内径、二尖瓣舒张早期血流充盈速度峰值(E)与二尖瓣舒张晚期血流充盈速度峰值(A)的比值(E/A)与HT组及对照组比较,均差异有统计学意义(均P<0.05),其中baPWV与PP、LVMI、BNP、E/A、E与二尖瓣环的间隔面和(或)侧壁面运动速率峰值(E’)的比值(E/E’)、早期二尖瓣减速时间有较好的相关性,而与左室射血分数、左室舒张末内径、左室收缩末内径无关。ROC曲线面积表明,当baPWV≥1 504 cm/s时,诊断DHF的敏感性75%,特异性73%。结论:baPWV是一种能反映传统危险因素的综合指标,能为早期发现高血压患者DHF提供依据,同时也为降压药物疗效的监测提供依据。
Objective: To evaluate the diagnostic value of ankle brachial pulse wave velocity (baPWV) in the early diagnosis of mild diastolic dysfunction (DHF) in hypertensive patients. Methods: Forty patients (HT-DHF group) with hypertension and mild DHF and 32 healthy subjects (control group) with age-matched DHF and 44 patients with HTF without DHF group). The baPWV was measured in all the subjects. The body mass index (BMI), pulse pressure (PP), brain natriuretic peptide (BNP) and echocardiography were measured simultaneously. Results: The HT-DHF group had dyslipidemia, the number of patients with diabetes mellitus and the difference between BMI group and HT group were statistically significant (all P <0.05). In the HT-DHF group, baPWV, PP, LVMI, BNP, left atrium diameter, mitral early diastolic flow filling velocity peak (E) and mitral early diastolic flow filling velocity peak There was significant difference between the ratio of E / A and HT group and control group (all P <0.05). The interval between baPWV and PP, LVMI, BNP, E / A and E (E / E ’) and early mitral valve decelerating time (E / E’) in the lateral walls of the left ventricle and the left ventricle, but not correlated with left ventricular ejection fraction, left ventricular end diastolic dimension End-systolic diameter has nothing to do. ROC curve area showed that when baPWV≥1 504 cm / s, the sensitivity and specificity of diagnosing DHF were 75% and 73% respectively. Conclusion: baPWV is a comprehensive index that can reflect the traditional risk factors. It can provide a basis for early detection of DHF in hypertensive patients and also provide a basis for monitoring the curative effect of antihypertensive drugs.