| Purpose:Exploring what the influence and its occurrence mechanism of obesity is to theleft atrial enlargement with essential hypertension in patients.Methods:151cases of patients with hypertension were collected, these hospitalized patientswere in the department of cardiology from2009to2011in our hospital,88cases ofmale and63female cases among them, aged18to60years. They were divided intotwo groups: there were77cases in simple hypertensive group, including39males and38females, the average age was47.90±7.01years old; there were74cases inhypertensive obesity group, including49males and25females, the average age was46.75±8.10years old. T-test and signed rank test were used to compare whether therewas statistical significance in the value of the age, gender, BMI, SBP, DBP, FPG, TC,TG, HDL, LDL, HR, course and echocardiographic left atrial diameter (LAD), leftatrial olume index (LAV), left atrial volume index (ILA), left ventricular end-diastolicdiameter (LVEDD), the thickness of interventricular septum (IVS), left ventricularwall thickness after (LVPW), left ventricular mass index (LVMI), left ventricularejection fraction (EF) and left ventricular shortening fraction (FS) in the two groups ofclinical data; The correlation between the left atrial volume index (ILA) and thevariables such as gender, age, BMI, systolic blood pressure, diastolic blood pressure,heart rate, FPG, TC, TG, HDL, LDL, LVPW, LVEDD, IVS, LVEF, LVFS, LVMI ofthe two groups patients are analysised by Person correlation analysis. Finally, therelevance between ILA and related factors was further clarified by the multiplestepwise regression analysis. Primary hypertension diagnosis was referred byHypertension prevention and control guidelines standards in China in2010. Obesitywas defined according to the working group on obesity advice that whose body massindex (BMI) greater than or equal to28(kg/m2) was obesity and their BMI=weight/height (kg/m2). The exclusive criteria:(1) secondary hypertension was causedby various reasons, such as renal hypertension, renal vascular hypertension, primary aldosteronism histiocytosis, pheochromocytoma, and coarctation of the aorta;(2) makeclear of the patients with rheumatic heart disease and rheumatic heart valve disease;(3)congenital heart disease;(4) chronic corpulmonale which is caused by lung disease;(5)ischemic heart disease;(6) the patients with myocarditis, cardiomyopathy and acutecardiac insufficiency unstable state;(7) pre-excitation syndrome syndrome;(8)sicksinus syndrome;(9) blood disease, tuberculosis, hyperthyroidism, diabetes, connectivetissue diseases, renal dysfunction, and other disorders that affect the heart cavitystructure.;(10) patients who stroke within3months;(11) people’s age was greaterthan60years old and younger than18.Results:1. The ILA of merge hypertension obesity group was23.86±6.56ml/m, and theILA of pure hypertension group was21.05±3.40ml/m.The ILA of mergehypertension obesity was greater than the pure hypertension group’s(P＜0.05).2. That the BMI, SBP, DBP were analyzed to ILA respectively by Pearsoncorrelation analysis showed that the correlation between BMI and ILA was bigger thansystolic blood pressure and diastolic blood pressure (r value were0.641,0.641and0.641, P＜0.05). After stepwise regression analysis, SBP and DBP both had nocorrelation with ILA, but there was still a significant correlation between BMI and ILA(β=0.944, P <0.01).3. The EF of merger obesity group and the simple hypertension group were60.45±8.49%and62.84±4.88%, and the FS of them were32.55±5.49%and33.92±3.56%. The EF and FS of merger obesity group were lower than them of the simplehypertension group (P＜0.05).4. The LVMI of obesity group of high blood pressure and pure hypertensiongroup were97.10±29.33g/㎡and88.06±17.83g/㎡, the LVMI of obesity groupwas greater than the pure hypertension group’s (P＜0.05). The results of Personcorrelation analysis between ILA and LVMI showed that the LVMI (r=0.550, P＜0.05)was associated with ILA, after multiple stepwise regression analysis,it found thatthe LVMI was still associated with ILA significantly (β=0.251, P＜0.01).5. The TG, LDL, FPG in merger obesity group and the simple hypertension grouprespectively were: TG was2.28±2.11mmol/land1.79±1.37mmol/l respectively, LDL was2.96±0.77mmol/l and2.78±0.80mmol/l respectively,FPG was5.80±1.12mmol/l and5.39±0.56mmol/l respectively, in merge hypertension obesity group, TG,LDL, FPG were greater than the simple hypertension group (P＜0.05). TG, LDL, FPGwere analyzed to ILA respectively by Pearson correlation analysis showed that FPGrespectively (r=0.271, P＜0.05) and TG (r=0.080, P<0.05) correlation with ILA.Conclusion:1. Obesity is one of the important influencing factors of left atrial enlargement inpatients with hypertension.2. Obesity led to ventricular diastolic dysfunction through increasing leftventricular mass, which led to increasing left atrial volume and power increased,resulting in increasing left atrial diameter.3. Obesity caused sugar lipid metabolism disorders, lipid could deposit withinmyocardial which caused the myocardial interstitial hyperplasia of secondarythickening, leading to ventricular diastolic dysfunction and further causing the leftatrial enlargement.4. Obesity activation of renin angiotensin system (RAS), promote myocardial cellproliferation and fibrosis,leading to atrial enlargement and influencing cardiac diastolicand systolic function at the same time, which can cause heart failure on the basis of it. |
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