新诊断的老年高血压患者动态血压节律及晨峰与肾功能损害的关系  

Association of ambulatory BP rhythm and morning BP surge with renal function damage in elderly hypertensive patients

作　　者：姜贵贤 邢莎莎[1] 马燕[1] 张红霞[1] 夏秀艳 叶琳[2] 刘振东[3] 栾萌[3] 

机构地区：[1]济南市历下区第三人民医院内科,250014 [2]山东省立医院心内科 [3]山东省医学科学院基础医学研究所

出　　处：《中华老年心脑血管病杂志》2015年第2期115-117,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：山东省自然科学基金(ZR2011HQ053;ZR2011HL053;ZR2012HL46);山东省科技发展计划项目(2012GGB14094);山东省医药卫生科技发展计划项目(2013WS0364)

摘　　要：目的探讨老年高血压患者24h血压节律及晨峰与肾功能损害的关系。方法选择老年高血压患者138例,根据24h动态血压节律分为杓型节律组61例和非杓型节律组77例。另根据血压晨峰情况再分为血压晨峰组79例和非血压晨峰组59例。检测各组微量白蛋白尿(MAU),采用适用于中国人的慢性肾脏病流行病学合作研究公式评估肾小球滤过率(GFR)。结果与非杓型节律组比较,杓型节律组MAU明显降低[(22.67±10.81)mg/L vs(38.92±16.34)mg/L,P<0.01],GFR明显升高[(105.93±16.47)ml/(min·1.73 m2)vs(90.61±10.73)ml/(min·1.73m2),P<0.01]。与非血压晨峰组比较,血压晨峰组MAU明显升高,GFR明显降低(P<0.01)。非杓型血压节律及收缩压晨峰是影响MAU及GFR的独立危险因素。结论 24h动态血压节律异常及晨峰现象是影响老年高血压患者肾功能损害的独立危险因素,两者具有交互协同作用。Objective To study the association of ambulatory BP rhythm and morning BP surge with renal function damage in elderly hypertensive patients. Methods One hundred and thirtyeight elderly hypertensive patients were divided into dipper rhythm group （n=61） and non-dipper rhythm group （n=77） according to their 24 h ambulatory BP and further divided into morning surge group （n=79） and non-morning surge group （n=59）. Their microalbumin urine （MAU） volume was measured and their glomerular filtration rate （GFR） was evaluated according to the CKD-EPI formula. Results The MAU volume was significantly lower while the GFR was significantly higher in dipper rhythm group than in non-dipper rhythm group [22.67 ± 10.81 mg/L vs 38.92±16. 34 mg/L,P〈0. 01;105. 93!16. 47 ml/（min · 1. 73 m^2） vs 90.61±10. 73 ml/ （min·1.73 m^2） ,P〈0.01]. The MAU volume was significantly higher while the GFR was significantly lower in dipper rhythm group than in non-dipper rhythm group （P〈0.01）. Non dipper BP rhythm and morning BP surge were the independent risk factors for MAU volume and GFR. Conclusion Twenty-four hours ambulatory BP rhythm and morning BP surge are the independent risk factors for renal function damge and play a synergistic role in renal function damage in elderly hypertensive patients.

关 键 词：高血压 血压监测 便携式 白蛋白尿 肾小球滤过率 危险因素 

分 类 号：R544.1[医药卫生—心血管疾病]