摘要
目的观察IgA肾病(IgAN)伴高血压患者昼夜血压节律改变尤其是夜间血压升高对临床、肾脏病理的影响。方法本研究为回顾性横断面研究,纳人伴高血压的IgAN患者83例,收集全部患者临床及肾脏病理资料,首先分析其24h动态血压特点;其次将纳入的IgAN患者按照血压节律改变的特点分为2组:夜间血压升高组及夜间血压正常组,比较两组间IgAN患者临床、病理的差异;再次采用Logistic回归分析IgAN患者肾小管间质损伤的影响因素;最后将所有IgAN患者按照估算的肾小球滤过率(eGFR)水平分为两组:eGFR<60ml·min^(-1)·(1.73m^2)^(-1)。组及eGFR≥60ml·min^(-1)·(1.73m^2)^(-1)组,比较两组间24h动态血压特点。结果(1)83例IgAN伴高血压患者中24h动态血压“非勺型”患者比例为79.5%。(2)与夜间血压正常组相比,夜间血压升高组尿蛋白量、血尿酸水平显著升高(均P<O.05),eGFR、禁水12h尿渗透浓度显著降低(均P<0.05);病理上肾小管间质损伤指数显著升高(P<0.05),但两组间肾小球缺血性病变比例差异无统计学意义(P>0.05)。(3)多因素Logistic回归分析结果提示夜间血压升高(OR=1.113,95%CI1.038-1.192,P=0.002)为肾小管间质损伤的独立危险因素。(4)eGFR<60ml·min^(-1)·(1.73m^2)^(-1)“组24h收缩压及舒张压、白昼收缩压及舒张压、夜间收缩压及舒张压均显著高于eGFR≥60ml·min^(-1)·(1.73m^2)^(-1)组(均P<0.05)。结论IgAN伴高血压患者非勺型血压昼夜节律比例高达79.5%。夜间血压升高与更重的肾脏损害有关,且夜间血压升高是IgAN伴高血压患者肾小管间质损伤的独立危险因素。故应重视24h动态血压监测,有效控制夜间血压,延缓IgAN肾功能进展。
Objective To investigate whether the clinical and pathological injury of kidney in IgA nephropathy (IgAN) patients with hypertension is associated with circadian blood pressure rhythm change,particularly with elevated nocturnal blood pressure (BP).Methods This study was a retrospective cross-sectional study.Clinic and renal histopathologieal injury data were obtained from 83 IgAN patients with hypertension.First,24h ambulatory BP monitoring (ABPM)data were analyzed. Second,all these IgAN patients were divided into two groups,elevated nocturnal BP group and nocturnal normotensive BP group,and the clinical and pathological differences between this two groups were analyzed.Third,logistic regression analysis was used to analyze the influencing factors of renal tubulointerstitial injury in IgAN patients with hypertension.At last,all these IgAN patients were divided into two groups according to the level of estimated glomerular filtration rate (eGFR),group of patients with eGFR≥60ml·min^(-1)·(1.73m^2)^(-1) and the other group with eGFR<60ml·min^(-1)·(1.73m^2)^(-1),and the 24h ABPM data were compared.Results (1)The proportion of non-dipper circadian rhythm of BP in IgAN patients with hypertension was 79.5%.(2)Compared with nocturnal normotensive BP group,patients in elevated nocturnal BP group had significantly higher levels of 24-hour urinary protein quantity and blood uric acid (both P <0.05),and lower eGFR and urine osmotic pressure clinically (both P <0.05).Index of interstitial fibrosis and tubular atrophy was significantly higher in nocturnal normotensive BP group (P <0.05),while the proportion of glomerular ischemia lesion was not significantly different between two groups.(3)Multivariate logistic regression analysis showed that elevated nocturnal BP was an independent risk factor for severe tubulointerstitial injury of IgAN (OR= 1.113,95% CI 1.038-1.192,P=0.002).(4)Compared with the group of eGFR≥60ml·min^(-1)·(1.73m^2)^(-1) ,24-hour systolic blood pressure (SBP)and diastolic blood pressure (DBP),daytime SBP and DBP, nocturnal SBP and DBP were significantly higher in group of eGFR<60ml·min^(-1)·(1.73m^2)^(-1) (all P < 0.05).Conclusion The proportion of non-dipper circadian rhythm of BP in IgAN patients with hypertension is as high as 79.5%.Elevated nocturnal BP is associated with the severity of renal damage,and elevated nocturnal BP is an independent risk factor for severe tubulointerstitial injury in IgAN patients with hypertension.Therefore,24h ABPM should be emphasized,and elevated nocturnal BP should be well controlled to slow the progression of IgAN.
作者
程文荣
程虹
张瑞雨
董鸿瑞
孙丽君
王国勤
董婧
谌贻璞
Cheng Wenrong;Cheng Hong;Zhang Ruiyu;Dong Hongrui;Sun Lijun;Wang Guoqin;Dong Jing;Chen Yipu(Division of Nephrology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2018年第12期881-886,共6页
Chinese Journal of Nephrology
基金
国家科技支撑计划项目(2011BAI1OB06)
首都卫生发展科研专项(首发2018-2-1051).
关键词
肾小球肾炎
IGA
血压
昼夜节律
血压监测
便携式
肾小管间质损伤
夜间血压
高血压
Glomerulonephritis,IgA
Blood pressure
Circadian rhythm
Blood pressure monitoring,ambulatory
Tubulointerstitial injury
Nocturnal blood pressure
Hypertension
