血糖达标且不伴高血压的2型糖尿病患者尿微量清蛋白与动态血压关系探讨  

Relationship between Microalbuminurine and Ambulatory Blood Pressure in Type 2 Diabetes Patients with Targeted Glucose Levels and No High Blood Pressure

作　　者：裴国勇[1] 

机构地区：[1]安徽省黄山市中医院内分泌科,安徽省黄山市245000

出　　处：《中国全科医学》2014年第10期1115-1118,共4页Chinese General Practice

摘　　要：目的探讨血糖达标且不伴高血压的2型糖尿病患者尿微量清蛋白(MAU)与24 h动态血压之间的关系。方法选取2012年1月—2013年5月在安徽省黄山市中医院内分泌科及代谢科住院及门诊的糖化血红蛋白(HbA1c)<7%且不伴高血压的2型糖尿病患者83例,按照尿MAU水平分为A组(MAU<30 mg/g,37例)和B组(MAU≥30 mg/g,46例),对两组患者的一般资料及动态血压指标进行分析比较。结果 (1)B组患者血肌酐值高于A组〔(76.1±14.6)μmol/L比(67.8±11.9)μmol/L〕,但肾小球滤过率低于A组〔(73.0±13.6)ml/min比(79.0±11.4)ml/min〕,差异有统计学意义(P<0.05);(2)B组24 h平均收缩压〔(128.9±6.2)mm Hg比(122.2±7.2)mm Hg〕、夜间平均收缩压〔(128.9±12.9)mm Hg比(113.8±10.0)mm Hg〕、夜间平均舒张压〔(78.0±8.6)mm Hg比(69.2±8.3)mm Hg〕、白昼收缩压负荷值〔(15.2±10.8)%比(9.8±7.5)%〕、夜间收缩压负荷值〔(54.5±34.3)%比(13.1±9.4)%〕、夜间舒张压负荷值〔(42.9±32.6)%比(9.6±8.7)%〕、夜间收缩压变异〔(11.2±4.4)比(10.9±4.3)〕及血压昼夜节律消失率(82.6%比37.8%)高于A组,差异有统计学意义(P<0.05);(3)多元逐步Logistic回归分析显示,年龄(β=0.097)、病程(β=0.127)、夜间收缩压负荷值(β=0.068)、夜间舒张压负荷值(β=0.077)及夜间收缩压变异(β=-0.229)是MAU的独立预测因子。结论对血糖达标且不伴高血压的2型糖尿病患者,24 h动态血压监测尤其是夜间血压变化对早期肾损伤具有预测价值。Objective To investigate the relationship between microalbuminurine （ MAU） and 24-hour ambulatory blood pressure （ 24 h -ABP ） in type 2 diabetes patients with targeted blood glucose levels but no high blood pressure.MethodsMedical records of 83 type 2 diabetes patients with glycated hemoglobin （ HbA1c ） 〈7% and no high blood pressure who were seeking treatment in Department of Endocrinology and Metabolism of Huangshan City ′s Hospital of Traditional Chinese Medicine were reviewed.Data on the demographic variables and 24h-ABP monitoring readings were stratified by the MAU concentration and accordingly analyzed.Results Plasma levels of creatine were significantly higher 〔 （ 76.1 ±14.6 ）μmol/L vs.（67.8 ±11.9） μmol/L, P〈0.01〕 but the estimated glomerular filtration rate was significantly lower 〔 （73.0 ± 13.6） ml/min vs.（79.0 ±11.4） ml/min, P〈0.05〕 in patients with MAU≥30 mg/g than patients with MAU〈30 mg/g.On average, the 24 h systolic blood pressure （BP） 〔 （128.9 ±6.2） mm Hg vs.（122.2 ±7.2） mm Hg, P〈0.01〕, nocturnal systolic BP 〔（128.9 ±12.9） mm Hg vs.（113.8 ±10.0） mm Hg, P〈0.01〕, nocturnal diastolic BP 〔（78.0 ±8.6） mm Hg vs.（69.2 ±8.3） mm Hg, P〈0.01〕, daytime systolic BP load 〔（15.2 ±10.8）%vs.（9.8 ±7.5）%, P〈0.05〕, noctur-nal systolic BP load 〔 （54.5 ±34.3）%vs.（13.1 ±9.4）%, P〈0.01〕, nocturnal diastolic BP load 〔 （42.9 ±32.6）%vs.（9.6 ±8.7）%, P〈0.01〕, standard deviation of nocturnal systolic BP 〔 （11.2 ±4.4） vs.（10.9 ±4.3）, P〈0.01〕, and disappearance rate of blood pressure circadian rhythm （ 82.6% vs.37.8%, P〈0.01 ） were all significantly higher in patients with MAU≥30 mg/L than patients with MAU 〈30 mg/L.Multivariate logistic regression analyses indicated age （β=0.097 ） , the disease course （β=0.127 ） , nocturnal systolic BP load （β=0.068 ） , nocturnal diastolic BP load （β=0.077 ） , and stand-ard deviation of nocturnal

关 键 词：糖尿病 2型 微量清蛋白尿 动态血压 

分 类 号：R587.1[医药卫生—内分泌]