动态血压监测在原发性高血压早期肾损害诊断中的临床研究  

Study of ambulatory blood pressure monitoring in diagnosis of early renal impairment by essential hypertension

作　　者：郭皓[1] 翟彪[1] 田青[1] 王玮[1] 胡大春[1] 

机构地区：[1]昆明市第一人民医院心内科,云南昆明650011

出　　处：《中国实用内科杂志》2007年第17期1366-1369,共4页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨动态血压均值、动态脉压及昼夜节律变化与微量蛋白尿的关系，为动态血压监测（ABPM）应用于早期诊断和评价高血压性肾损害提供科学依据。方法选择2003年6月至2004年10月昆明市第一人民医院心内科住院的原发性高血压患者125例，测量动态血压各参数：24h平均收缩压（24hSBP）、24h平均舒张压（24hDBP）、24h平均脉压（24hPP）等及尿微量白蛋白（mAlb）、尿N-乙酰-β—D-氨基葡萄糖苷酶（NAG）。（1）根据动态血压测量的结果将受试者按24hPP≤40mmHg（1mmHg=0．133kPa）、41～55mmHg、56-70mmHg、〉70mmHg分为A、B、C、D组，比较各组的尿mAlb、NAG检测值及其阳性率，行24hSBP、24hDBP、24hPP与尿mAlb、NAG的相关回归分析。（2）根据血压昼夜节律变化，将上述受试者分为“杓型”组和“非杓型”组，比较两组尿mAlb、NAG检测值及其阳性率。结果（1）A组与B组之间，尿mAlb、NAG及微量蛋白尿阳性率差异无显著性意义（P〉0．05），B组、C组与D组随24hPP的增高，尿mAlb、NAG及微量蛋白尿阳性率依次明显增高，各组间差异有显著性意义（P〈0．05）。（2）24hPP与尿mAlb、NAG呈正相关（r=0．79、0．78，P〈0．05），24hSBP与尿mAlb、NAG呈正相关（r=0．78、0．76，P〈0．05），24hDBP与mAlb、NAG呈负相关（r=-0．64、-0．65，P〈0．05）；建立多元回归方程得出高血压早期肾损害时对应的24hSBP、24hDBP及24hPP值分别为150mmHg、91mmHg、58mmHg。（3）“非杓型”组尿mAlb、NAG及微量蛋白尿阳性率明显高于“杓型”组，两组间差异有显著性意义（P〈0．05）。结论动态血压均值、动态脉压及昼夜节律变化可为原发性高血压患者早期肾损害的检测评价指标，24hSBP高于150mmHg、24hPP高于58mmHg，24hDBP过度下降的患者易出现高血压性肾损害，夜间血压下降率〈10％的患者为原发性高血压性肾损害的高危患者。Objective To investigate the relationship between 24-hour mean blood pressure, pulse pressure, diurnal blood pressure rhythm and microproteinuria for diagnosis and evaluation of early renal impairment in essential hypertension patients. Methods The 125 essential hypertension patients were studied. The data was collected and studied,including 24-hour mean systolic blood pressure （24hSBP） , 24-hour mean diastolic blood pressure （24hDBP） , 24 hours mean pulse pressure （24hPP） , urine microalbumin （ mAlb ） , n-acetyl-β-d-glucosaminidase （NAG） and so on. The subjects wei＇e divided into four groups on the basis of the 24hPP ： group A （ ≤40 mm Hg） , group B （ 41 - 55 mm Hg） , group C （ 56-70 mm Hg） and group D（ 〉70 mm Hg）. Meanwhile,the subjects were divided into “dipper” and “non-dipper” group according to diurnal blood pressure rhythm. The urine mAlb, NAG and microproteinuria in each group were compared respectively. Correlationship between 24hSBP, 24hDBP, 24hPP and urine mAlb, NAG was analyzed. Results （ 1 ） Urine mAlb ,NAG and microalbuminufia were not significantly different in groupA and group B（ P 〉 0. 05 ）. They increased accordingly with ascending level of 24hPP in groups B, C and D（ P 〈 0. 05 ）. （2）The urine mAlb and NAG were positively correlated with 24hPP（ r = 0. 79,0. 78 ,P 〈 0. 05 ） and 24hSBP（ r = 0. 78,0. 76, P 〈 0.05 ） and negatively correlated with 24hDBP（ r = - 0. 64, - 0. 65, P 〈 0. 05 ）. When 24hSBP = 150 mm Hg,24hDBP＇= 91 mm Hg, 24hPP = 58 mm Hg, we found the early renal impairment by multiple equation of linear regression. （3） The data between “dipper” group and “non- dipper”group was significantly different （ P 〈 0. 05 ）. Conelusion The 24hSBP,24hDBP,24hPP and diurnal blood pressure rhythm can be considered as the evaluation indexes of hypertensive renal impairment. The renal function was affected easily when 24hSBP 〉 150 mm Hg,24hPP 〉 58 mm Hg and 24bDBP descend significantly. Diur

关 键 词：高血压 动态血压均值 动态脉压 昼夜节律变化 肾损害 

分 类 号：R5[医药卫生—内科学]