维持性血液透析患者透析间期血压节律影响因素的分析  

Factors analysis on circadian rhythm of interdialytic blood pressure in maintenance hemodialysis patients

作　　者：李亚霖[1] 牛建英[1] 陶琳[1] 汪鹏[1] 李鹏[1] 范伟峰[1] 罗丽红[1] 张绮[1] 顾勇[2] 

机构地区：[1]复旦大学附属上海市第五人民医院肾内科,上海200240 [2]复旦大学华山医院肾内科复旦大学肾脏病研究所

出　　处：《中华肾脏病杂志》2008年第4期235-239,共5页Chinese Journal of Nephrology

摘　　要：目的观察维持性血液透析患者透析间期血压节律可能存在的异常并讨论其影响因素。方法选择44例维持性血液透析患者，均于透析间期f透析前1d）进行24h动态血压监测，根据动态血压监测结果将患者分为3组：非高血压组、高血压控制组及高血压未控制组。监测或评估3组患者的血红蛋白（Hb）、血肌酐（Scr）、Kt／V、血清钙（Ca）、磷（P）、全段甲状旁腺素（iPTH）、透析间期体质量增加（IDWG）、Morisky依从性评分等。对相应的指标进行统计分析，筛选出影响血压节律的因素。结果（1）动态血压相关参数包括夜间血压下降率、收缩压和舒张压的夜间下降率、动态动脉硬化指数（AASI）、杓形血压比例在3组之间的差异无统计学意义。高血压未控制组的24h平均脉压比其他两组高[（80．06±13．41）比（53．00±7．73）、（57．85±21．97）mmHg，均P〈0．01]。（2）3组患者血压曲线均呈现“两峰一谷”的表现，高血压未控制组夜间血压下降不明显。（3）夜间收缩压下降率与血iPTH呈负相关（r=-0．349，P=0．0241。（4）44例患者中的全部10例杓型血压节律者的AASI与夜间舒张压下降率呈负相关（r=-0．748，P=0．0131。结论维持性血液透析患者夜间血压下降与甲状旁腺素及血管硬化程度有关。Objective To describe the circadian profiles of interdialytic blood pressure in maintenance hemodialysis patients and to investigate its related factors. Methods Ambulatory blood pressure monitoring （ABPM） was conducted in forty-four patients on regular hemodialysis during interdialytic days. Three groups were identified with their ambulatory blood pressure： non-hypertension group, controlled hypertension group and uncontrolled hypertension group. Hemoglobin, creatinine, Kt/V, serum total calcium, serum phosphate, immunoreactive parathyroid hormone （iPTH）, interdialytic weight gain and Morisky self-report scale etc. were assessed. Results （1） No significant difference was found in ABPM index ranged from decline in nocturnal systolic and diastolic blood pressure, AASI to dipper percentage in three groups. Nevertheless, 24-h average pulse pressure in uncontrolled hypertension group was higher than the other groups [（80.06±13.41 ） vs （53.00±7.73）, （57.85±21.97） mm Hg, all P〈0.01]. （2） All the three groups showed the blood pressure profile of double-peak and trough. In the uncontrolled hypertension group, however, the nocturnal blood pressure decrease was not notable. （3） Nocturnal systolic blood pressure decline was negatively correlated to iPTH （r=-0.039, P〈0.05）. （4） In ten dippers out pressure dec correlated to of all 44 patients, AASI was negatively correlated with nocturnal diastolic blood line （r=-0.748, P〈0.05）. Conclusion Nocturnal blood pressure decline is iPTH and arterial sclerosis

关 键 词：肾透析 昼夜节律 高血压 动态血压监测 甲状旁腺激素 

分 类 号：R692.5[医药卫生—泌尿科学]