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目的:探讨高海拔地区原发性高血压合并红细胞增多症患者心脏重构的特点。方法:236例住院高血压患者按是否合并红细胞增多症分为红细胞正常组和红细胞增多症组,比较两组年龄、病程、移居高原时间、血压水平、心脏结构的变化以及心脏重构的发生率。结果:红细胞增多症组患者年龄水平小于红细胞正常组[(50.39±13.77):(57.30±12.13)岁](P<0.05),舒张压水平高于红细胞正常组[(103.51±13.30):(97.14±15.26)mmHg(1mmHg=0.133kPa)](P<0.05)。红细胞增多症组患者右心房左右径、右室舒张末内径、右室流出道、左心房前后径、舒张末室间隔厚度和舒张末左室后壁厚度,与红细胞正常组比较明显增大[(39.16±6.31):(34.15±5.44)mm、(38.85±7.71):(33.96±5.09)mm、(25.83±4.67):(23.36±2.35)mm、(34.11±4.56):(32.25±5.60)mm、(12.88±1.67):(12.03±1.83)mm和(12.29±1.75):(10.88±1.65)mm](均P<0.05)。红细胞增多症组患者右心房扩大、右心室扩大和左室肥厚罹患率显著高于红细胞正常组(24.6%:8.4%、27.5%:9.0%和79.7%:58.1%)(均P<0.05);而左心房和左心室扩大的罹患率在2组间比较差异无统计学意义(P>0.05)。结论:在高海拔地区原发性高血压合并红细胞增多症患者心脏重构特点以右心系统改变更显著。
Objective: To investigate the characteristics of cardiac remodeling in patients with essential hypertension complicated with polycythemia at high altitude. Methods: A total of 236 inpatients with hypertension were divided into normal group and polycythemia group according to whether they were complicated with polycythemia or not. The age, course of disease, time to migrate to plateau, blood pressure level, changes of cardiac structure and the incidence of cardiac remodeling . Results: The age of patients with polycythemiamia group was lower than that of the normal erythrocyte group [(50.39 ± 13.77) :( 57.30 ± 12.13) years] (P <0.05), and the diastolic blood pressure was higher than that of the normal erythrocyte group [(103.51 ± 13.30) :( 97.14 ± 15.26) mmHg (1 mmHg = 0.133 kPa)] (P <0.05). Right atrium left ventricular diameter, right ventricular end-diastolic diameter, right ventricular outflow tract, left atrium anteroposterior diameter, diastolic ventricular septal thickness and left ventricular posterior wall thickness of patients with polycythemia group were significantly increased compared with the normal group [( 39.16 ± 6.31), (34.15 ± 5.44) mm, (38.85 ± 7.71) :( 33.96 ± 5.09) mm, (25.83 ± 4.67) :( 23.36 ± 2.35) mm, (34.11 ± 4.56) :( 32.25 ± 5.60) mm , (12.88 ± 1.67) :( 12.03 ± 1.83) mm and (12.29 ± 1.75) :( 10.88 ± 1.65) mm respectively (all P <0.05). The incidence of right atrium enlargement, right ventricular enlargement and left ventricular hypertrophy in patients with polycythemia was significantly higher than that in the normal group (24.6% vs 8.4%, 27.5% vs 9.0% and 79.7% vs 58.1%, respectively) (all P <0.05). The incidence of left atrium and left ventricular enlargement in the two groups was no significant difference (P> 0.05). Conclusion: The characteristics of cardiac remodeling in patients with essential hypertension complicated with polycythemia at high altitudinal changes are more obvious in the right heart.