The Diagnostic Value Vectorcardiogram the Early Stage Hypertensive Heart Target Organ Damage Analysis Influencing Factors
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摘要:
目的 探讨心电向量图(vectorcardiogram,VCG)对高血压心脏电活动异常的诊断价值,并分析早期心脏靶器官损害的影响因素。 方法 选取昆明市中医医院心血管病科2022年1月至2023年2月的高血压病住院患者80例,经超声心动图(ultrasound cardiogram,UCG)排外心脏结构异常。比较心电图(electrocardiogram,ECG )与VCG对异常心室除极与复极指标的检出情况。按心电向量检查结果将80例病例分为正常组(n = 40)与异常组(n = 40),比较2组早期心脏损害的相关影响因素指标,将差异有统计学意义的因素做二元Logistic回归分析,筛选出早期心脏损害的独立影响因素。 结果 VCG检出异常心室复极指标较ECG有优势(P < 0.05),二者对异常除极指标的检出差异无统计学意义(P > 0.05)。正常组与异常组比较,在年龄、规律服药、家族史、糖尿病、24 h平均收缩压(24 h average systolic blood pressure,24 h SBP)、白昼平均收缩压(daytime average systolic blood pressure,DSBP)、夜间平均收缩压(night average systolic blood pressure,NSBP)、血压负荷值、清晨血压、脉压差等指标上,差异有统计学意义(P < 0.05)。二元Logistic回归分析显示,年龄[OR(95%CI)=0.891,0.998]、夜间平均收缩压[OR(95%CI)=1.018,2.10]、家族史[OR(95%CI)=0.029,0.499]、糖尿病[OR(95%CI)=0.042,0.916]是高血压早期心脏损害的独立影响因素。 结论 VCG为高血压早期心脏靶器官损害的有效检测手段。 Abstract:Objective To investigate the value of vectorcardiography in the diagnosis of abnormal cardiac electrical activity in hypertension, and to analyze the influencing factors of early cardiac target organ damage. Methods 80 cases in the Department of Cardiovascular of Kunming Municipal Hospital of Traditional Chinese Medicine from January 2022 to February 2023, were selected.Cardiac structural abnormalities were excluded by ultrasound cardiogram. The detection of abnormal ventricular depolarization and repolarization indexes was compared between electrocardiogram and vectorcardiogram. 80 cases were divided into normal group (n = 40) and abnormal group (n = 40) according to the results of vectorcardiogram, the related influencing factors of early cardiac damage were compared between the two groups, and the indicators with statistical significance were included in the binary Logistic regression analysis to screen out the independent influencing factors of early heart damage. Results Vectorcardiogram was superior to ECG in detecting abnormal ventricular repolarization indexes (P < 0.05), and there was no significant difference in detecting abnormal depolarization indexes between the two groups (P > 0.05). There were significant differences between the normal group and the abnormal group in age, regular medication, family history, diabetes, 24 h average systolic blood pressure (24 h SBP), daytime average systolic blood pressure (DSBP), night average systolic blood pressure (NSBP), blood pressure load, morning blood pressure, and pulse pressure (P < 0.05). Binary Logistic regression analysis showed, that age [OR (95%CI) = 0.891, 0.998] and NSBP [OR (95%CI) = 1.018, 2.10], family history [OR (95% CI) = 0.029, 0.499], diabetes [OR = 0.042 (95%CI), 0.916] were the independent influencing factors of early cardiac damage in hypertension. Conclusion Vectorcardiogram is an effective method to detect early cardiac target organ damage in hypertension. -
表 1 ECG与VCG对异常心室除极与复极指标的检出情况比较
Table 1. Comparison of detection of abnormal ventricular depolarization and repolarization indices between ECG and VCG
指标 ECG(n) VCG(n) χ2 P 心室除极 正常 36(45.00%) 33(41.25%) 3.252 0.071 异常 4(5.00%) 7(8.75%) 心室复极 正常 63(78.75%) 41(51.25%) 9.756 0.002* 异常 17(21.25%) 39(48.75%) *P < 0.05。 表 2 正常组与异常组的高血压早期心脏靶器官损害相关影响因素的单因素分析($\bar x \pm s $)M(P25,P75)
Table 2. Univariate analysis of influencing factors related to early cardiac target organ damage in hypertensive patients among normal and abnormal groups ($\bar x \pm s $)M(P25,P75)
指标 正常组(n=40) 异常组(n=40) t/Z/χ2 P 性别 男 13 18 1.371 0.251 女 27 22 年龄(岁) 51.13±12.42 58.78±15.25 2.460 0.016* 体重指数(kg/m2) 23.61(21.21~25.58) 23.95(22.16~26.35) 1.386 0.166 高血压病史(a) ≥5 16 14 0.213 0.644 <5 24 26 规律服药 是 19 29 5.208b 0.022* 否 21 11 家族史 有 14 27 8.455 0.004* 无 26 13 糖尿病 是 9 18 4.528 0.033* 否 31 22 吸烟史 有 12 9 0.581 0.446 无 28 31 饮酒史 有 6 5 0.105 0.745 无 34 35 作息规律 是 35 35 0.000 1.000 否 5 5 高盐饮食 是 14 11 0.524 0.469 否 26 29 24 h SBP(mmHg) 116.03±11.14 125.25±16.86 2.887 0.005* 24 h DBP(mmHg) 70.48±9.81 74.33±10.35 1.707 0.092 DSBP(mmHg) 118.33±11.79 126.83±16.99 2.600 0.011* DDBP(mmHg) 72.40±10.25 76.00±10.47 1.554 0.124 NSBP(mmHg) 109.50(102.00~118.00) 118.00(109.25~131.75) 2.812 0.005* NDBP(mmHg) 63.85±9.42 70.03±10.86 1.837 0.070 SBP负荷(%) 10.85(1.85~24.00) 25.15(5.80~52.70) 2.681 0.007* DBP负荷(%) 6.10(1.93~22.55) 15.95(5.18~41.23) 2.087 0.037* 清晨SBP(mmHg) 117.46±13.89 128.20±19.68 2.820 0.006* 清晨DBP(mmHg) 72.20±10.32 77.55±11.08 2.237 0.028* SBP变异性(%) 10.83±2.52 10.81±2.41 0.036 0.971 DBP变异性(%) 12.42±4.28 11.57±3.42 0.975 0.333 SBP节律 杓型 12 10 0.251 0.617 非杓型 28 30 DBP节律 杓型 20 15 1.270 0.260 非杓型 20 25 脉压差(mmHg) 44.00(40.00~53.00) 52.00(42.00~58.00) 2.485 0.013* 血尿酸(μmol/L) 351.50(324.25~428.50) 364.00(321.75~426.75) 0.154 0.878 高密度脂蛋白(mmol/L) 1.22±0.31 1.24±0.25 0.295 0.771 低密度脂蛋白(mmol/L) 3.01±1.00 3.07±0.93 0.288 0.774 总胆固醇(mmol/L) 4.05±1.42 3.67±1.44 1.177 0.243 甘油三酯(mmol/L) 1.47(1.20~1.99) 1.49(1.10~2.36) 0.120 0.904 空腹血糖(mmol/L) 5.01(4.55~5.54) 5.02(4.56~5.67) 0.457 0.648 *P < 0.05。 表 3 高血压早期心脏靶器官损害的影响因素的Logistic回归分析
Table 3. Logistic regression analysis of factors influencing early cardiac target organ damage in hypertension
指标 B 标准误 Wals 自由度 P OR 95%CI 年龄 −0.058 0.029 4.050 1 0.044* 0.943 0.891~0.998 24 h SBP −1.158 0.647 3.206 1 0.073 0.314 0.088~1.116 DSBP 0.885 0.476 3.466 1 0.063 2.424 0.954~6.155 NSBP 0.380 0.185 4.237 1 0.040* 1.463 1.018~2.101 清晨SBP 0.013 0.036 0.133 1 0.716 1.013 0.944~1.088 清晨DBP −0.085 0.051 2.803 1 0.094 0.919 0.832~1.015 SBP负荷 −0.048 0.039 1.549 1 0.213 0.953 0.884~1.028 DBP负荷 −0.027 0.019 1.939 1 0.164 0.973 0.937~1.011 脉压差 −0.071 0.047 2.270 1 0.132 0.932 0.850~1.021 家族史 有 −2.123 0.728 8.498 1 0.004* 0.120 0.029~0.499 无 0 1 糖尿病 有 −1.628 0.786 4.291 1 0.038* 0.196 0.042~0.916 无 0 1 常量 2.139 7.224 0.088 1 0.767 8.494 *P < 0.05;赋值:无家族史=0,有家族史=1;无糖尿病=0,有糖尿病=1。 -
[1] 方锐,郭海成,杨勇,等. 近20年高血压及靶器官损害风险因素研究趋势可视化分析[J]. 中国老年学杂志,2019,39(21):5140-5147. doi: 10.3969/j.issn.1005-9202.2019.21.002 [2] 国家心血管病中心国家基本公共卫生服务项目基层高血压管理办公室,国家基层高血压管理专家委员会. 国家基层高血压防治管理指南 2020 版[J]. 中国循环杂志,2021,36(3):209-220. [3] 刘桂芝,常超,闫书妹,等. 兔心脏压力超负荷左心室肥大的电学和形态学改变[J]. 第二军医大学学报,2017,38(1):66-73. [4] 惠汝太. 高血压早期靶器官损害的研究进展[J]. 中国循环杂志,2018,30(10):929-931. [5] 孙恕,易松. 2023年《中国高血压防治指南》更新临床实践[J]. 心电与循环,2023,42(3):203-206. doi: 10.12124/j.issn.2095-3933.2023.3.2023-5497 [6] 龙佑玲,苏勇,刘明,等. 临床心电向量图解析[M]. 昆明: 云南科技出版社,2021: 23-26; 34-40. [7] 郭继鸿. 心电图学[M]. 北京: 人民卫生出版社,2002: 119-138; 143-153; 660-661 . [8] 赵冬. 中国成人高血压流行病学现状[J]. 中国心血管杂志,2020,25(6):513-515. doi: 10.3969/j.issn.1007-5410.2020.06.001 [9] Lunde Ida G,Herum Kate M,Carlson Cathrine C,et al. Syndecans in heart fibrosis[J]. Cell and Tissue Research,2016,365(3):539-552. doi: 10.1007/s00441-016-2454-2 [10] 胡春阳,殷国田,余悦欣. 不同年龄大鼠急性心肌梗死后早期胶原纤维变化与心功能的关系[J]. 广东医药,2017,38(9):13-15. [11] Ueda H,Miyawaki M,Hiraoka H. High-normal blood pressure is associated with new-onset electrocardiographic left ventricular hypertrophy[J]. J Hum Hypertens,2015,29(1):9-13. doi: 10.1038/jhh.2014.21 [12] 欧阳欢,黄丽云,陈舒玲,等. 清醒时不同时间血压水平预测夜间高血压的价值[J]. 中国循环杂志,2024,39(2):156-163. [13] 曾勇,张稳,刘丹,等. 高血压病左心室肥厚形成影响因素的研究进展[J]. 中国循环杂志,2013,28(6):477-478. doi: 10.3969/j.issn.1000-3614.2013.06.022 [14] 束长城,魏万林. 高血压左心室肥厚的形成机制研究进展[J]. 中国循证心血管医学杂志,2018,10(6):760-762. doi: 10.3969/j.issn.1674-4055.2018.06.35 [15] 辛颖,宋晓东,王虎,等. NOS3基因多态性与高血压继发左心室肥厚的关联[J]. 中国分子心脏病学杂志,2010,11(3):152-157. [16] 张雷,刘欢欢,王如兴. 糖尿病所致心室电重构及其机制[J]. 中国心脏起搏与心电生理杂志,2023,37(5):422-424. [17] 王超,张萍. 高血压左心室肥厚形成机制的研究进展[J]. 重庆医学,2015,44(22):3143-3145. doi: 10.3969/j.issn.1671-8348.2015.22.049 [18] 龙佑玲,潘登,熊田珍,等. 心电向量图诊断高血压病在左心室异常的临床应用[J]. 昆明医科大学学报,2021,42(4):113-116. doi: 10.12259/j.issn.2095-610X.S20210421 [19] 龙佑玲,熊田珍,苏勇,等. 心电向量分析指标预测高血压左心室肥厚的临床价值[J]. 中西医结合心脑血管病杂志,2021,24(19):4369-4371. -