维持性血液透析患者清晨高血压与心脑血管事件的关系  

Correlation between morning hypertension and cardiovascular and cerebrovascular events in maintenance hemodialysis patients

作　　者：唐雪莲[1,2] 万静芳[1] 林利容[1] 卢晓梅[1,2] 霍本刚[1] 何娅妮[1] 李开龙[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所肾内科,重庆400042 [2]第三军医大学

出　　处：《中国血液净化》2015年第8期474-477,共4页Chinese Journal of Blood Purification

基　　金：国家十二五支撑计划项目(No.2011BAI10B08)

摘　　要：目的探讨维持性血液透析(MHD)患者清晨高血压(MH)与心脑血管事件的关系。方法选取174例MHD伴高血压患者采用动态血压监测仪记录44h血压,根据清晨血压分为清晨高血压组(MH组,104例)和非清晨高血压组(NMH组,70例),其中MH组分3型:持续型、非持续型、激增型。记录发生的心脑血管事件,随访2年,比较2组患者一般资料、心脑血管事件发生率及死亡率。结果与NMH组相比,MH组透析间期体质量增加值、睡眠障碍发生率、清晨收缩压、心脑血管事件发生率(67.3%比40%)和死亡率(13.5%比2.9%)明显升高(P<0.05),单室尿素清除指数(sp Kt/V)值显著低于NMH组(t=10.743,P<0.01);亚组中持续型患者心脑血管事件发生率(75.4%)高于激增型(66.7%)和非持续型(40%)(c2=8.815,P<0.05),3亚组间心脑血管事件死亡率无显著差异(c2=0.798,P>0.05);MH组患者清晨收缩压值与心脑血管事件发生率呈正相关(r=0.700,P<0.01)。结论 MHD伴高血压患者MH与心脑血管事件发生率密切相关,可能是心脑血管事件的独立危险因素。Objective To investigate the correlation between morning hypertension （MH） and cardiovas-cular and cerebrovascular events in maintenance hemodialysis （MHD） patients. Methods Ambulatory blood pressure monitoring was done in 174 MHD patients with hypertension. They were classified as MH group （n=104） and non-MH group （n=70） based on the morning blood pressure. MH group was further classified into 3 types： sustained type, non-sustained type, and surge type. They were followed up for 2 years, and cardiovascu-lar and cerebrovascular events were recorded. General information, mortality and the incidence of cardiovas-cular and cerebrovascular events were compared between the two groups. Results Compared to non-MH group, weight gain in dialysis interval, the incidence of sleep disorders, morning systolic blood pressure （MSBP）, the incidence of cardiovascular and cerebrovascular events （67.3% vs. 40%） and mortality （13.5%vs. 2.9%） were significantly increased （P〈0.05） but spKt/V was significantly decreased （t =10.743, P〈0.01） in MH group. The incidence of cardiovascular and cerebrovascular events was significantly higher in sus-tained type （75.4%） than in surge type （66.7%） and non-sustained type （40%） （c2=8.815, P〈0.05）, but the mortality was indifferent among the 3 types in MH group （c2=0.798, P〉0.05）. The value of MSBP was posi-tively correlated with the incidence of cardiovascular and cerebrovascular events in MH group （r=0.700, P〈0.01）. Conclusion MH closely correlates with the incidence of cardiovascular and cerebrovascular events in MHD patients with hypertension. MH may be an independent risk factor of cardiovascular and cerebrova-seuar events.

关 键 词：维持性血液透析 清晨高血压 心脑血管事件 

分 类 号：R318.16[医药卫生—生物医学工程]