原发性高血压伴左心室肥厚患者常规治疗效果的影响因素分析

Analysis of factors affecting the therapeutic efficacy of conventional treatment for essential hypertension patients with left ventricular hypertrophy

摘要:

目的 探讨原发性高血压（EH）伴左心室肥厚（LVH）患者常规治疗效果的影响因素。方法 选取2018年1月—2020年1月在河北北方学院附属第一医院接受厄贝沙坦治疗的400例EH伴LVH患者为研究对象，根据治疗效果将其分为有效组（359例）、无效组（41例），比较两组患者一般资料、治疗前间歇性左束支传导阻滞（LBBB）发生率及心率变异性（HRV）指标，采用多因素Logistics回归分析EH伴LVH患者治疗效果不佳的影响因素。结果 治疗后，有显效、有效、无效患者分别为269例、90例、41例，有效率为89.75%。两组患者性别及入院时极低频、低频（LF）/高频（HF）比较，差异无统计学意义（P >0.05）；两组患者年龄、高血压病程、入院时血压、入院时LVH、入院时间歇性LBBB发生率，以及入院时正常RR间期标准差（SDNN）、相邻RR间期之差的均方根（RMSSD）、相邻RR间期差值> 50 ms的RR间期所占百分数、HF、LF比较，差异有统计学意义（P <0.05）。多因素Logistic回归分析结果显示：年龄≥ 65岁、高血压病程≥ 10年、入院时舒张压较高、收缩压较高、入院时LVH重度肥大、入院时发生间歇性LBBB，以及入院时SDNN、RMSSD、HF、LF是EH伴LVH患者常规治疗无效的危险因素（P <0.05）。结论 EH伴LVH患者常规治疗效果受多种因素影响，其中合并间歇性LBBB、HRV降低与EH伴LVH患者常规治疗后疗效不佳有关。

Abstract:

Objective To investigate the factors affecting the therapeutic efficacy of conventional treatment for essential hypertension (EH) patients with left ventricular hypertrophy (LVH).Methods Four hundred patients with EH and LVH who received irbesartan treatment in our hospital from January 2018 to January 2020 were selected and divided into effective group (n = 359) and ineffective group (n = 41) according to the therapeutic efficacy. The general data, the incidence of intermittent left bundle branch block (LBBB) and heart rate variability (HRV) indexes before treatment were compared between the two groups. The factors potentially contributing to poor curative effects in EH patients with LVH were analyzed by multivariable Logistic regression.Results The treatment was markedly effective in 269 cases, effective in 90 cases, and ineffective in 41 cases, with the overall effective rate being 89.75%. There was no significant difference in gender or VLF and LF / HF at admission between the two groups (P > 0.05). However, there were significant differences in age, course of hypertension, blood pressure, the degree of LVH, the incidence of intermittent LBBB, SDNN, RMSSD, pNN50, HF and LF at admission between the two groups (P < 0.05). The multivariable Logistic regression showed that age ≥ 65 years, course of hypertension ≥ 10 years, high diastolic and systolic blood pressure at admission, severe LVH at admission, the presence of intermittent LBBB at admission and SDNN, RMSSD, HF and LF at admission were the risk factors for the failure of conventional treatment in EH patients with LVH (P < 0.05).Conclusions The therapeutic efficacy of conventional treatment for EH patients with LVH is affected by a myriad of factors, among which the combination of intermittent LBBB and reduced HRV are related to the poor effect.