高血压与心肌纤维化的系统综述与荟萃分析
本研究通过系统检索EMBASE、PubMed等数据库，纳入39项研究、45,776名参与者，评估高血压与心肌纤维化的关系。结果显示高血压与胶原容积分数、初始T1值及细胞外容积分数升高显著相关。部分药物如氯沙坦、雷米普利、培哚普利可减轻心肌纤维化，而氨氯地平与氢氯噻嗪未显示显著缓解作用。
要点
- 高血压患者心肌纤维化可通过心脏MR T1 mapping定量评估，ECV%和初始T1值均显著升高。
- 心肌纤维化程度与左心室肥厚、心力衰竭及血压升高相关，阅片时应重点关注。
- 抗高血压药物对心肌纤维化影响不同，氯沙坦、雷米普利、培哚普利可减轻纤维化。
核心结论
- 高血压与心肌纤维化指标显著相关，包括胶原容积分数、初始T1值和细胞外容积分数。
- 心肌纤维化水平较高与左心室肥厚、心力衰竭及血压升高有关。
- 氯沙坦、雷米普利和培哚普利有助于控制血压并减轻心肌纤维化，而氨氯地平与氢氯噻嗪未显示统计学显著的缓解作用。
研究设计与样本
- 系统综述与荟萃分析，检索EMBASE、PubMed、Cochrane Library和Google Scholar数据库。
- 纳入39项观察性及干预性研究，共45,776名参与者。
- 心肌纤维化评估方法为组织学检查或心脏磁共振T1 mapping参数，包括细胞外容积分数和初始T1值。
诊断标准与关键数值
- 胶原容积分数：加权均数差为4.66，95%置信区间为2.57至6.75。
- 初始T1值：加权均数差为38.34，95%置信区间为16.30至60.37。
- 细胞外容积分数：加权均数差为1.89，95%置信区间为0.66至3.12。
临床应用与阅片要点
- 对高血压患者行心脏MR T1 mapping检查，初始T1值和ECV%升高提示心肌纤维化可能。
- 阅片时注意心肌纤维化与左心室肥厚、心力衰竭的关联，结合血压水平综合评估。
- 在高血压患者中识别心肌纤维化程度对其临床管理有重要意义。
- 选择抗高血压药物时需考虑不同药物对心肌纤维化的影响差异，优先考虑能减轻纤维化的药物。
局限性
- 原文未报告研究设计层面的局限性，如纳入研究的偏倚风险及异质性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Hypertension (HTN) is a major risk factor for myocardial fibrosis (MF), a key contributor to cardiac dysfunction. This meta-analysis aims to evaluate the relationship between HTN and MF using data from imaging and histological studies.
METHODS: This study was searched EMBASE, PubMed, Cochrane Library, and Google Scholar to identify observational and interventional studies evaluating the association between HTN, blood pressure (BP), and antihypertensive medications with MF, assessed by histology or cardiac magnetic resonance imaging (T1 mapping parameters: extracellular volume fraction [ECV%] and native T1 values).
RESULTS: A total of 39 studies comprising 45,776 participants were included in the analysis. The meta-analysis showed that HTN was significantly related to MF indicators, including collagen volume fraction (weighted mean difference [WMD]: 4.66; 95% confidence interval [CI]: 2.57 to 6.75), native T1 values (WMD: 38.34; 95% CI: 16.30 to 60.37), and ECV% (WMD: 1.89; 95% CI: 0.66 to 3.12). Higher MF levels correlated with left ventricular hypertrophy, heart failure, and elevated BP. Losartan, ramipril, and perindopril help control BP and attenuate MF, while amlodipine and hydrochlorothiazide do not statistically significantly alleviate MF.
CONCLUSIONS: The extent of MF is closely associated with various factors, underscoring the importance of its identification in hypertensive patients. Histology and T1 mapping parameters are effective for quantifying MF. Due to the variable effects of antihypertensive medications on MF, the use of specific agents to mitigate MF in hypertensive patients is recommended.
引用
- Jiang, Deng, Dong, et al. Hypertension and myocardial fibrosis: A systematic review and meta-analysis. Clin Radiol. 2026. PMID: 42296937. doi:10.1016/j.crad.2026.107391
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。