2型糖尿病睡眠障碍患者动态血压节律与尿白蛋白排泄率的关系  

The association between ambulatory blood pressure rhythm and urinary albumin excretion rate in type 2 diabetes with sleep disorder patients

作　　者：任惠珠[1] 陈莉明[1] 郑妙艳[1] 杨菊红[1] 王颖[1] 单春艳[1] 常宝成[1] 

机构地区：[1]天津医科大学代谢病医院内分泌研究所卫生部激素与发育重点实验室,300070

出　　处：《中华糖尿病杂志》2015年第5期291-296,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金（81173428、81373864）

摘　　要：目的：研究2型糖尿病（T2DM）睡眠障碍患者动态血压节律与尿白蛋白排泄率的关系。方法应用匹兹堡睡眠质量指数（PSQI）将2012年5月至2014年5月于天津医科大学代谢病医院住院的373例T2DM患者分为无睡眠障碍组（267例）和睡眠障碍组（106例），并以尿白蛋白排泄率再分为正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组。分析两组间及各亚组间平均血压、血压昼夜节律、平滑指数和血压变异性等变化，对睡眠障碍和尿白蛋白排泄率行回归分析。多组间比较采用单因素方差分析，两两比较采用LSD-t检验。结果（1）睡眠障碍组平均血压、血压变异系数高于无睡眠障碍组[分别为平均收缩压（130.3±10.1）比（125.5±9.3）mmHg；平均舒张压：（74.1±8.0）比（70.3±8.0）mmHg（1 mmHg=0.133 kPa）；24 h收缩压变异系数：8.2±2.0比7.3±1.8；24 h舒张压变异系数：10.1±2.4比9.3±2.3；均P〈0.05]，夜间血压下降百分率、血压平滑指数低于无睡眠障碍组（t=2.9924～5.3979，均P〈0.05）。（2）随着尿白蛋白排泄率的增加，无睡眠障碍和睡眠障碍各亚组血压升高、变异系数增加、夜间血压下降百分率和平滑指数下降，睡眠障碍各亚组变化更明显（t=2.0073～4.0395，均P〈0.05）。（3）睡眠障碍与24 h收缩压、夜间收缩压、尿白蛋白排泄率呈正相关，与夜间收缩压下降百分率呈负相关（Wald=4.192、4.590、6.019、5.910，均P〈0.05）。尿白蛋白排泄率与PSQI总分、夜间舒张压、夜间收缩压呈正相关，与夜间收缩压下降百分率呈负相关（β=0.224、0.251、0.287、-0.242，均P〈0.05）。结论T2DM睡眠障碍患者异常的血压昼夜节律可能与尿白蛋白排泄率有关。Objective To investigate the association between ambulatory blood pressure rhythm and urinary albumin excretion rate （UAER） in type 2 diabetes with sleep disorder patients. Methods Three hundred and seventy three in-patients with type 2 diabetes treated from May 2012 to May 2014 in Metabolic Disease Hospital of Tianjin Medical Universitywere divided into two groups according to Pittsburgh Sleep Quality Index（PSQI）：patients without sleep disorder （267） and patients with sleep disorder （106）. The groups were further divided into normoalbuminuria group, microalbuminuria group and macroalbuminuria group by UAER. The changes of the average blood pressure, the circadian rhythm of blood pressure, the smoothness index of blood pressure and blood pressure variation were analyzed between the two groups and each subgroup. The regression analysis were performed between sleep disorder as well as UAER and other indicators.One-way ANOVA was used to analyze data among multiple groups. LSD-t test was used to analyze data between two groups. Results （1）The average blood pressure as well as coefficient variations of blood pressure was significant higher and the decreasing percentage of blood pressure at night and smoothness index of blood pressure was significant lower in patients with sleep disorder than those in patients without＆nbsp;sleep disorder（t=2.9924-5.3979,all P〈0.05）.（2）The average blood pressure and coefficient variation of blood pressure increased and the decreasing percentage of blood pressure at night and smoothness index of blood pressure decreased in all with and without sleep disorder subgroup patients with the increasing UAER. Significant changes of the above indicators were in sleep disorder subgroup（t=2.0073-4.0395,all P〈0.05）. （3）sleep disorder was positively related to 24 h systolic blood pressure, systolic blood pressure at night and UAER,whereas was negatively related to the decreasing percentage of systolic blood pressure at night（ Wald=4.192,4.590,6.019,5.910,

关 键 词：糖尿病 2型 睡眠障碍 动态血压 昼夜节律 尿白蛋白排泄率 

分 类 号：R587.2[医药卫生—内分泌]