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目的应用间位碘代苄基胍(123I-MIBG)心肌显像研究高血压病心脏交感神经功能变化特征及其与心脏结构、功能变化的关系。方法对25例原发性高血压病患者(14例伴心室肥厚的LVH组和11例不伴心室肥厚的HT组)、5例肾性高血压病患者(RVHT组)和8例正常血压对照者(NT组)进行早期和延迟123I-MIBG心肌显像,比较4组间早期和延迟的心脏/纵隔摄取比(H/M比)和心脏MIBG洗脱率,并对洗脱率与心脏超声获得的左室收缩功能[左心射血分数(LVEF)]、左室舒张功能(A/E比)及左室质量指数(LVMI)进行相关性分析。结果各组间早期和延迟H/M比未见显著差异;LVH组和RVHT组的MIBG洗脱率明显高于HT组和NT组(34±3%和28±2%vs.17±2%和17±4%,P分别<0.01和0.05);心脏MIBG的洗脱率与LVMI和左室舒张功能呈正相关,r分别为0.645和0.324(P分别<0.01和0.05),而与左室收缩功能未见明显相关性。结论原发性高血压病合并左室肥厚和肾性高血压病患者心脏MIBG的清除明显加速,提示左室结构变化和肾素-血管紧张素系统功能亢进直接影响心脏MIBG的代谢,改变心脏交感神经系统的功能状态。
Objective To study the changes of cardiac sympathetic nerve function and its relationship with changes of cardiac structure and function in patients with essential hypertension by using meta-iodobenzylguanidine (123I-MIBG) myocardial imaging. Methods Twenty-five patients with essential hypertension (LVH group with ventricular hypertrophy and 11 HT patients without ventricular hypertrophy), 5 patients with renal hypertension (RVHT group) and 8 normal controls (NT group). The early and delayed 123I-MIBG myocardial imaging was performed. The early and delayed cardiac / mediastinal uptake ratio (H / M ratio) and cardiac MIBG elution rate were compared between the 4 groups. The elution rate and cardiac ultrasound The left ventricular systolic function (LVEF), left ventricular diastolic function (A / E ratio) and left ventricular mass index (LVMI) were analyzed. Results There was no significant difference in the early and delayed H / M ratios between groups. The MIBG elution rates in LVH group and RVHT group were significantly higher than those in HT group and NT group (34 ± 3% and 28 ± 2% vs 17 ± 2% And 17 ± 4%, respectively, P <0.01 and 0.05, respectively). The elution rate of MIBG in heart was positively correlated with LVMI and diastolic function (r = 0.645 and 0.324, P <0.01 and 0.05, respectively) No significant correlation of function. Conclusions The clearance of MIBG in the heart of patients with essential hypertension complicated by left ventricular hypertrophy and renal hypertension is accelerated obviously. It suggests that the changes of left ventricular structure and the function of renin-angiotensin system directly affect the metabolism of MIBG in the heart and alter the sympathetic The functional status of the nervous system.