糖尿病肾脏疾病动脉硬化指数及其影响因素分析  

Ambulatory Arterial Stiffness Index and Associated Factors in Patients with Diabetic Kidney Disease

作　　者：陈利佳[1] 吴敏[1] 冯延欢[1] 黄佑群[1] 臧丽[1] 付平[1] 刘芳[1] 

机构地区：[1]四川大学华西医院肾脏内科,成都610041

出　　处：《四川大学学报（医学版）》2015年第1期57-61,共5页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金(No.81370823);四川省科技厅科技支撑计划项目(No.2013SZ0035)资助

摘　　要：目的分析糖尿病肾脏疾病与非糖尿病肾脏疾病患者动脉硬化程度的差异及其影响因素。方法纳入44例糖尿病肾脏疾病患者(DKD组)和31例非糖尿病肾脏疾病患者(NDKD组),均合并高血压。通过24h动态血压监测血压数值从而得到短时血压变异性及动态动脉硬化指数(AASI)值。协方差分析比较两组患者短时血压变异性及AASI值的差异,相关分析初步了解与糖尿病肾脏疾病患者AASI相关的各种因素,进一步进行多重线性回归分析得到影响糖尿病肾脏疾病患者AASI的主要因素。结果协方差分析(排除年龄的影响)显示DKD组患者24h收缩压变异性(24hSBPV)、白昼收缩压变异性均大于NDKD组(P<0.05),同时,将DKD组患者AASI(0.55±0.14)与NDKD组患者AASI(0.45±0.16)相比较,其差异存在统计学意义(P<0.05),DKD组患者动脉硬化程度更严重。相关分析显示糖尿病肾脏疾病患者AASI与24hSBPV、24h舒张压变异性(24hDBPV)、白昼舒张压变异性(dDBPV)、夜间收缩压变异性(nSBPV)、夜间舒张压变异性(nDBPV)相关,多重线性回归分析结果提示AASI主要受到nDBPV和年龄的影响。结论糖尿病肾脏疾病及非糖尿病肾脏疾病患者均存在一定程度的动脉硬化,而前者AASI升高更显著,同时,糖尿病肾脏疾病患者短时血压变异性较非糖尿病肾脏疾病患者更大。DKD患者AASI受到年龄、nDBPV的显著影响。Objective To compare arterial stiffness between diabetic kidney disease and non-diabetic kidney diseaseand to identify factors predicting ambulatory arterial stiffness index （AASI）. Methods Forty-four patients with diabetic kidney disease （DKD group） and thirty-one patients with non-diabetic kidney disease （NDKD group） were recruited for this study. All of the participants had hypertension. The AASI （indirect reflex global arterial stiffness）and short-term blood pressure variability （BPV） were measured using a 24-h ambulatory BP monitoring, and compared between DKD and NDKD groups using analyses of covariance, correlation analysis and multivariate linear regression model. Results DKD patients had significantly higher levels of AASI than NDKD patients （0. 55 ±0. 14 vs. 0. 45 ±0.16, P〈0. 05）. The 24-h systolic and daytime systolic BP variability of DKD patients was also higher than NDKD patients. In DKD patients, the correlation analysis revealed that the AASI showed association with 24-h systolic BP variability （24 hSBPV）, 24-h diastolic BP variability （24 hDBPV）, daytime diastolic BP variability （dDBPV） ,riighttime systolic BP variability （nSBPV） and nighttime diastolic BP variability（nDBPV）, and nDBPV and age showed strong associations with AASI. Conclusion Although both DKD and NDKD patients suffered from arterial stiffness, greater AASI and short-term BPV was detected in DKD patients. AASI is associated with nDBPV and age. Optimal short-term BPV control in hypertensive type 2 diabetic patients with overt nephropathy may improve arterial elasticity.

关 键 词：动态动脉硬化指数 短时血压变异性 糖尿病肾脏疾病 慢性肾脏疾病 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学]