2型糖尿病肾病患者动态血压变化与微量白蛋白尿的相关性  

The association between 24 h ambulatory blood pressure and microalbuminuria in patients with type 2 diabetic nephropathy

作　　者：孙红喜[1] 陈莉明[1] 杨菊红[1] 单春艳[1] 郑妙艳[1] 王颖[1] 任慧珠[1] 温娟娟[1] 郭俊[1] 宋新荣[1] 常宝成[1] 

机构地区：[1]天津医科大学代谢病医院糖尿病肾病科,卫生部激素与发育重点实验室,300070

出　　处：《中华高血压杂志》2011年第8期779-783,共5页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81072922);天津市自然科学基金(10JCYBJC13200);天津医科大学科技项目(20090703)

摘　　要：目的探讨糖尿病肾病(DN)患者24h动态血压变化,分析其与尿白蛋白的相关性。方法按Mogensen分期将患者194例分为4组:正常白蛋白尿组(尿白蛋白≤30mg/24h,n=71),微量白蛋白尿(MAU)组(尿白蛋白30～<300mg/24h,n=47)、大量白蛋白尿组(尿白蛋白≥300mg/24h,n=31)及肾功能不全组[尿白蛋白≥300mg/24h且eGFR≤60mL/(min·1.73m2),n=43]。观察各组动态血压、血压昼夜节律、平滑指数等的变化,分析其与尿白蛋白的相关性。结果随尿白蛋白增加及肾功能下降,24h、白昼及夜间的收缩压和舒张压均逐渐升高[24h平均收缩压由正常白蛋白尿组(125.4±14.6)增至肾功能不全组(146.6±13.3)mmHg,舒张压由(66.9±8.9)增至(83.0±8.8)mmHg,P<0.05],24h收缩压标准差由(9.3±2.2)增至(11.9±4.8)mmHg(P<0.05),收缩压及舒张压平滑指数逐渐降低(4组收缩压平滑指数分别为1.82±0.3、1.75±0.3、1.64±0.2、1.56±0.2,P<0.05)。Pearson相关分析显示,24h血压变化、血压标准差与24h尿白蛋白呈正相关(P<0.01),而夜间血压下降率及平滑指数与24h尿白蛋白呈负相关(P<0.05)。结论早期DN患者存在血压昼夜节律异常,且血压变异性增大。Objective To investigate the relationship between the 24 h ambulatory blood pressure and microalbuminuria in type 2 diabetic nephropathy patients.Methods 194 patients were divided into 4 groups according to Mogensen stage：normal albuminuria （U｜Alb≤30 mg/24 h,n=71）,microalbuminuria （U｜Alb 30-300 mg/24 h,n=47）,mass albuminuria （U｜Alb≥300 mg/24 h,n=31） and kidney function insufficiency U｜Alb≥300 mg/24 h and eGFR≤mL/（min·1.73 m2）,n=43.The variation,circadian rhythm and the smoothness indexes of blood pressure in each group were examined,and the associations between them and microalbuminuria were analyzed.Results With the increase of urinary microalbumin and the decrease of renal function,24｜hour,diurnal systolic and diastolic blood pressure increased significantly （24｜hour mean systolic blood pressure：normal albuminuria group （125.4±14.6） vs kidney function insufficiency group （146.6±13.3）mm Hg,diastolic blood pressure：（66.9±8.9） vs （83.0±8.8）mm Hg,all P0.05,standard deviation of 24｜hour systolic pressure increased from （9.3±2.2） to （11.9±4.8） mm Hg （P0.05）,smoothness indexes of systolic and diastolic blood pressure decreased （the smoothness indexes of systolic blood pressure in four groups：1.82±0.3,1.75±0.3,1.64±0.2 and 1.56±0.2,all P0.05）.Pearson correlation analysis showed that the variation of 24｜hour blood pressure and blood pressure standard deviation were positively correlated with 24｜hour urinary microalbumin （P0.01）,while the percentage of systolic blood pressure during night and smooth index were negatively correlated with 24｜hour urinary microalbumin（P0.05）.Conclusion Impaired circadian rhythm and the increased fluctuations of blood pressure were presented in early diabetic nephropathy patients.

关 键 词：2型糖尿病 糖尿病肾病 动态血压 微量白蛋白尿 昼夜节律 

分 类 号：R587.2[医药卫生—内分泌]