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高血压患者左心室肥厚的定义与发病机制

Authors
Pamela S Douglas, MD
Norman M Kaplan, MD
Section Editor
George L Bakris, MD
Deputy Editors
John P Forman, MD, MSc
Gordon M Saperia, MD, FACC
Translators
余国龙, 主任医师，教授

引言

左心室肥厚(left ventricular hypertrophy, LVH)是确定或临界高血压患者的一种常见表现，可经心电图(electrocardiograph, ECG)或超声心动图诊断[1,2]。由于不同的心电图诊断标准对轻度LVH的诊断敏感性可能低至7%-35%，对中度至重度LVH的敏感性也仅为10%-50%，所以超声心动图是诊断LVH的首选操作[3]。如一项轻度高血压治疗研究报告显示，844例患者中几乎没有一例达到心电图诊断LVH标准，而13%的男性病例和20%的女性病例经超声心动图证实存在LVH[按体表面积校正，见下文][4]。然而，如果不能获得超声心动图检测或检测费用太高，可采用恰当的心电图标准检测左室质量的增加[5,6]。(参见“左心室肥大的心电图诊断”)

高血压患者LVH的定义与发病机制总结在此，此并发症治疗的临床意义和效果，以及高血压患者行超声心动图的指征将单独讨论。(参见“高血压患者左心室肥大的临床意义及治疗”)

定义

LVH定义为左室质量增加，可继发于室壁厚度增加、心腔扩大或这两者同时存在时。高血压引起的LVH通常表现为左室壁厚度增加，伴或不伴心腔扩大。左室质量增加主要是由于高血压导致慢性左室后负荷增加，但也有遗传因素影响。其病理机制是每个心肌细胞内肌小节数量和/或大小显著增加。

左室质量的估计值通常由经二维超声心动图获得的左心室测量值得出。美国超声心动图学会与欧洲超声心动图学会一起发布了以下运用改良辛普森定律的LVH诊断标准[7]：

  • 估算的左室质量男性201-227g(103-116g/m2)，女性151-171g(89-100g/m2)为轻度异常
  • 估算的左室质量男性228-254g(117-130g/m2)，女性172-182g(101-112g/m2)为中度异常
  • 估算的左室质量男性大于255g(>131g/m2)，女性大于193g(>113g/m2)为严重异常

       

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Literature review current through: 2017-06 . | This topic last updated: 2015-09-29.
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