超重和肥胖对老年高血压患者心脏结构和功能的影响

Effect of overweight and obesity on cardiac structure and function in elderly patients with hypertension

摘要:

目的：探讨超重和肥胖对老年高血压患者心脏结构和功能的影响。方法：收集2014年4月至2018年4月重庆医科大学附属第一医院≥65岁的原发性高血压患者1 183例。收集患者的性别、年龄、体质量、收缩压、舒张压等临床资料。收集左房内径（left atrial diameter，LAD）、室间隔厚度（interventricular septal thickness，IVST）、左室后壁厚度（left ventricular posterior wall thickness，LVPWT）、左室舒张期末内径（left ventricular end-diastolic diameter，LVDd）等患者的心脏超声参数，并计算出左室质量（left ventricular mass，LVM）和左室质量指数（left ventricular mass index，LVMI）。体质指数（body mass index，BMI）＜18.5 kg/m2共61例为低体质量组，18.5 kg/m2≤BMI＜23 kg/m2共375例为正常体质量组，23 kg/m2≤BMI＜27.5 kg/m2共530例为超重组，BMI≥27.5 kg/m2共217例为肥胖组。比较4组患者的临床资料和心脏超声参数的差异，分析BMI与上述指标的相关性，最后对BMI与有相关性的指标进行有序多元回归分析。结果：单因素相关分析发现，BMI与性别、体质量、吸烟率、饮酒率、高血压病史、收缩压、2型糖尿病构成比、空腹血糖、糖化血红蛋白、脂肪肝和痛风构成比、心功能、主动脉内径、IVST、LVPWT、LVDd、左室收缩期末内径（left ventricular end-systolic diameter，LVDs）、LAD、LVM、LVMI、二尖瓣环舒张早期与晚期血流峰值速度比值（mitral peak early flow velocity/mitral peak late flow velocity，E/A）＜1的患者构成比正相关（P＜0.05），与年龄、高密度脂蛋白胆固醇（high density lipoprotein cholesterin，HDL-C）、左室短轴缩短率（left ventricular fraction shortening，LVFS）、左室射血分数（left ventricular ejection fraction，LVEF）负相关（P＜0.05）。在包含有性别、体质量、收缩压、高血压病史、IVST、LVPWT、LVDd、LVDs等指标的有序多元回归显示，BMI与IVST、LVPWT、LVDd、LVM、LVMI独立相关（P＜0.05）。结论：在老年高血压患者中，超重和肥胖可独立导致IVST、LVPWT增大，LVDd增大，LVM、LVMI增加。但超重和肥胖与心脏收缩和舒张功能未发现独立相关。

Abstract:

Objective：To investigate the effect of overweight and obesity on cardiac structure and function in elderly patients with hypertension. Methods：A total of 1183 patients ≥65 years of age with primary hypertension who were admitted to the First Affiliated Hospital of Chongqing Medical University from April 2014 to April 2018 were enrolled. The clinical data of patients including sex，age，body weight，systolic pressure，and diastolic pressure were collected. The echocardiographic parameters such as left atrial diame－ter（LAD），interventricular septal thickness（IVST），left ventricular posterior wall thickness（LVPWT），and left ventricular end-dias－tolic diameter（LVDd） were recorded，and left ventricular mass（LVM） and left ventricular mass index（LVMI） were calculated. Ac－cording to body mass index（BMI），61 patients were assigned to low-weight group（BMI<18.5 kg/m2），375 to normal-weight group （18.5 kg/m2≤BMI<23 kg/m2），530 to overweight group（23 kg/m2≤BMI<27.5 kg/m2），and 217 to obesity group（BMI≥27.5 kg/m2）. The clinical data and echocardiographic parameters were compared between the four groups，the correlation of BMI with the above indicators was analyzed，and an ordered multivariate regression analysis was conducted on BMI and correlated indicators. Results：Univariate correlation analysis showed that BMI was positively correlated with sex，body weight，smoking rate，alcohol consumption rate，history of hypertension，systolic pressure，constituent ratio of type 2 diabetes mellitus，fasting blood glucose，glycosylated hemoglobin，constituent ratios of fatty liver and gout，cardiac function，aortic dimension，IVST，LVPWT，LVDd，left ventricular end-systolic diameter（LVDs），LAD，LVW，LVMI，and consti－tution ratio of patients with mitral ratio of peak early to late di－astolic filling velocity（E/A）<1（P<0.05），but negatively corre－lated with age，high-density lipoprotein cholesterol，left ventricular fraction shortening（LVFS），and left ventricular ejection fraction（LVEF）（P<0.05）. The ordered multivariate regression analysis of sex，body weight，systolic pressure，history of hypertension，IVST，LVPWT，LVDd，LVDs，and other indicators showed that BMI was independently correlated with IVST，LVPWT，LVDd，LVM，and LV－MI（P<0.05）. Conclusion：In elderly patients with hypertension，overweight and obesity may lead to thicken the IVST and the LVPWT，enlargement of LVDd，and increases in LVM and LVMI. However，overweight and obesity are not independently correlated with cardiac systolic and diastolic function.