摘要
目的研究不同肾功能水平的慢性肾脏病（chronickidneydisease，CKD）患者24h动态血压特点，探讨血压变异性与肾功能损伤之间的关系。方法选择上海交通大学附属瑞金医院肾脏科的CKD住院患者509例，收集并记录患者的基本信息、实验室检查数据，采用携带式动态血压检测仪监测患者24h动态血压参数，采用GEVivid7彩色超声心动图检查仪记录患者左心室质量指数（1eftventricular massindex，LVMI）参数。采用SPSS15．o统计软件进行数据统计分析。结果本研究共纳入CKD患者509例，其中CKD1期102例（占20．0％），CKD2期107例（占21．0％），CKD3期114例（占22．4％），CKD4期97例（占19．1％），CKD5期89例（占17．5％）。随着CKD患者肾功能水平的下降，患者的24h平均收缩压逐渐升高（P〈0．05），而24h平均舒张压的改变无统计学差异（P〉0．05）。CKD4期和5期患者的白昼平均收缩压、夜间平均收缩压、夜间平均舒张压明显高于CKD1～3期患者（P〈0．05），而白昼平均舒张压的差异则无统计学意义。CKD4期和5期患者的24h收缩压标准差（24h systolic standard deviation，24hSSD）、白天收缩压标准差（day systolic standard deviation，dSSD）、夜间收缩压标准差（night systolic standard deviation，nSSD）明显高于CKD1～3期患者（P〈0．05），而24h舒张压标准差（24h diastolic stand arddeviation，24hDSD）、白天舒张压标准差（daydiastolic standard deviation，dDSD）、夜间舒张压标准差（night diastolic standard deviation，nDSD）则无统计学差异（P〉0．05）。CKD患者非杓型血压的比例随肾功能下降逐渐升高，CKD1期患者的非杓型血压比例为54．1％，而CKD5期患者的非杓型血压比例甚至高达85．6％。LVMI异常的CKD患者的24hSSD及dSSD高于LVMI正常的CKD患者（P〈0．05），而nDSD，nSSD，dDSD，24hDSD的差异无统计学意义。结论随着CKD患者肾功能下降及平均血压水平升高，血压变异性增加，血压昼夜节律减退，非杓型血压比例增加。控制血压水平及调整血压昼夜节律对CKD患者的治疗具有重要意义。
Objective To investigate the 24-h ambulatory blood pressure among chronic kidney disease （CKD） patients and the relationship between blood pressure variability （BPV） and target organ damage. Methods We recruited 509 CKD patients from Ruijin Hospital, Shanghai Jiaotong University in the study. The clinical data, including patients＂ characteristics, laboratory examination were collected, patients＂ ambulatory blood pressure （ABP） was monitored using portable detector （Spacelabs 90207）, and patients＂ LVMI was recorded using color Doppler echocardiogram tester （GEVivid7）. We used SPSS 15. 0 to analyze the data. Results A total of 509 CKD patients were included in the study, including 102 cases of CKD1 （20. 0%）, 107 cases of CKD2 （21.0%）, 114 cases of CKD3 （22. 4%）, 97 cases of CKD4 （19. 1%） and 89 cases of CKD5 （17. 5%）. 24-h SBP in CKD patients was significantly increased with decreased kidney function （P〈0. 05）. The dSBP, nSBP, nDBP in CKD4, and 5 patients were significantly higher than those in patients with CKD 1, 2, and 3 （P〈0. 05）, but there was no significant difference in dDBP. The 24-h SSD, dSSD and nSSD in patients with CKD4, and 5 were significantly higher than those in patients with CKD 1, 2, and 3 （P〈0. 05）, but there was no significant difference in 24-h DSD, dDSD and nDSD. The rate of non-dipper blood pressure was normally high in CKD patients. The rate was 54. 1% in CKD1 patients, and increased with decreased kidney function, which reached up to 85. 6% in CKD5 patients. The 24-h SSD and dSSD in CKD patients with abnormal LVMI were significantly higher than those in CKD patients with normal LVMI （P〈0. 05）, but there was no significant difference in nDSD, nSSD, dDSD and 24-h DSD. Conclusions The blood pressure, BPV and rate of non-dipper blood pressure in CKD patients increased with decreased kidney function. Measures to control CKD patients blood pressure and to improve circadian rhythm of blood pressure are essential for the management of CKD.
出处
《临床肾脏病杂志》
2016年第2期71-75,共5页
Journal Of Clinical Nephrology
基金
国家自然基金项目(NO.30600291)
关键词
慢性肾脏病
肾损伤
血压变异
左心室肥厚
非杓型血压
Chronic kidney disease
Kidney injury
Blood pressure variability
Left ventricular hypertrophy
Non-dipper blood pressure
