动态血压节律变化在糖尿病肾病早期诊断中的价值  

Value of variation in circadian rhythm of blood pressure for early diagnosis of diabetic nephropathy

作　　者：孙红喜[1] 陈莉明[1] 常宝成[1] 单春艳[1] 郑妙艳[1] 杨菊红[1] 任慧珠[1] 王颖[1] 温娟娟[1] 郭俊[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,天津300070

出　　处：《中华内分泌代谢杂志》2013年第5期368-373,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金（81072922,81173428）;天津市卫生局科技基金（2010KZ91）

摘　　要：目的 探讨“亚临床”糖尿病肾病患者24 h动态血压变化规律。方法 选取190例2型糖尿病患者，根据估算的肾小球滤过率（eGFR）水平分为肾小球高滤过率组和肾小球滤过率正常组，并以尿白蛋白水平再进行分组，分析各组动态血压、血压昼夜节律、平滑指数等变化规律。结果 （1）随尿白蛋白增加，2型糖尿病患者24 h、白昼及夜间的收缩压和舒张压均逐渐升高（P＜0.05），24 h收缩压标准差和变异系数逐渐升高，收缩压及舒张压平滑指数逐渐降低（P＜0.05）；（2）尿蛋白正常的肾小球高滤过率组患者已经开始出现血压节律异常，且随24 h尿白蛋白增加，夜间收缩压及舒张压下降百分率均逐渐降低（P＜0.05），而在微量白蛋白尿基础上，一旦发展为大量白蛋白尿，有85.7%患者失去正常血压节律。结论“亚临床”糖尿病肾病患者存在血压昼夜节律异常和血压变异性增大。Objective To investigate the change of 24 h ambulatory blood pressure in patients with subclinical diabetic nephropathy. MethodsA total of 190 type 2 diabetic patients were divided into 2 groups according to estimated glomerular filtration rate（eGFR）： glomerular hyperfiltration （eGFR≥120 ml·min-1·1.73 m-2,n=65）, normal glomerular filtration rate（90≤eGFR〈120 ml·min-1·1.73 m-2,n=125）. The groups were further divided by means of 24-hour urinary albuminuria. The variation in the ambulatory blood pressure, the circadian rhythm of blood pressure, the smoothness index of blood pressure in each group were analyzed. Results（1） Along with the increasing microalbuminuria, 24-hours, diurnal, and night systolic and diastolic blood pressure increased progressively in the diabetic patients （P〈0.05）, 24-hours standard deviation and coefficient variation of systolic blood pressure increased, and smoothness index of systolic and diastolic blood pressure decreased progressively （P〈0.05）. （2） In the patients with glomerular hyperfiltration but normal albuminuria, the incidence of abnormal blood pressure rhythmicity began to increase; and that of lowering of systolic and diastolic blood pressure during night became less evident along with increasing microalbuminuria （P〈0.05）. With the progression of microalbuminuria to macroalbuminuria, 85.7% patients lost normal blood pressure rhythmicity. ConclusionAbnormal circadian rhythm of blood pressure and increased variation in blood pressure occur in patients with ＂subclinical＂ diabetic nephropathy.

关 键 词：糖尿病肾病 动态血压 肾小球滤过率 微量白蛋白尿 昼夜节律 

分 类 号：R544.1[医药卫生—心血管疾病]