慢性肾脏病患者24h动态血压变化特点的临床研究  

Clinical Characteristics of 24-hour Ambulatory Blood Pressure Variation in Patients With Chronic Kidney Disease

作　　者：赵鑫[1] 热西旦·扎克尔[1] 黄萱[1] 张双艳[1] 桑晓红[1] 王梅红[1] 刘健[1] 李素华[1] 

机构地区：[1]新疆医科大学第一附属医院肾内科,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国全科医学》2016年第1期48-53,共6页Chinese General Practice

基　　金：新疆维吾尔自治区自然科学基金资助项目(2013211A091)--新疆维吾尔族CRP基因多态性与慢性肾脏病的相关研究

摘　　要：目的探讨不同阶段慢性肾脏病（CKD）患者24 h血压动态变化特点。方法选取2012年9月—2014年9月新疆医科大学第一附属医院肾内科住院的CKD患者362例,根据肾小球滤过率（GFR）分为5组：CKD1期组101例、CKD2期组83例、CKD3期组90例、CKD4期组56例、CKD5期组32例。采用携带式动态血压仪监测各组患者动态血压指标、昼夜节律,同时测量相关临床指标。结果 CKD4、5期患者24 h平均收缩压（24 h-SBP）、24 h平均舒张压（24 h-DBP）、日间平均收缩压（d-SBP）、日间平均舒张压（d-DBP）、夜间平均收缩压（n-SBP）、夜间平均舒张压（n-DBP）均高于CKD1~3期患者,差异有统计学意义（P〈0.05）。CKD患者中,深杓型、杓型、非杓型及反杓型血压者分别占1.9%（7/362）、19.1%（69/362）、54.7%（198/362）、24.3%（88/362）;CKD1~2期即可见非杓型和反杓型血压模式。非杓型、反杓型患者n-SBP、n-DBP、夜间脉压均高于杓型患者,夜间舒张压下降率、夜间收缩压下降率均低于杓型患者,差异有统计学意义（P〈0.05）。24 h尿微量清蛋白〉300 mg患者24 h-SBP、24 h-DBP、d-SBP、d-DBP、n-SBP、n-DBP均高于24 h尿微量清蛋白〈30、30~300 mg患者,差异有统计学意义（P〈0.05）。结论随着肾功能恶化进展,CKD患者血压水平逐渐上升,以非杓型、反杓型血压模式为主,且早期即有昼夜节律异常表现;随着尿微量清蛋白水平升高,收缩压及舒张压逐渐升高。Objective To investigate the characteristics of 24- hour ambulatory blood pressure variation of patients with chronic kidney disease（ CKD） at different stages. Methods We enrolled 362 CKD patients who were admitted into Department of Nephrology of the First Affiliated Hospital of Xinjiang Medical University from September 2012 to September2014. According to glomerular filtration rate（ GFR）,the patients were divided into 5 groups： CKD1 group（ n = 101）,CKD2group（ n = 83）,CKD3 group（ n = 90）,CKD4 group（ n = 56）,CKD5 group（ n = 32）. Ambulatory blood pressure indexes and circadian rhythm of the patients of each group were monitored by portable ambulatory blood pressure monitoring（ ABPM）,and relevant clinical indexes were also monitored at the same time. Results CKD4 and CKD5 patients were higher than CKD1,CKD2 and CKD3 patients in 24 h-SBP,24 h-DBP,d-SBP,d-DBP,n-SBP and n-DBP（ P〈0. 05）. Of all the CKD patients,the patients with deep- dipper BP pattern,dipper BP pattern,non- dipper BP pattern and reversed dipper BP pattern accounted for 1. 9%（ 7 /362）,19. 1%（ 69 /362）,54. 7%（ 198 /362） and 24. 3%（ 88 /362） respectively; non- dipper BP pattern and reversed dipper BP pattern were noted in CKD1 patients and CKD2 patients. Patients with non- dipper BP pattern and reversed dipper BP pattern were higher in n-SBP,n-DBP and night pulse pressure and lower in the decrease rates of night diastolic pressure and night systolic pressure than patients with dipper BP pattern（ P〈0. 05）. Patients with 24 h urine microalbumin 300 mg were higher than patients with 24 h urine microalbumin 〈30 or between 30 ~ 300 mg in 24 h-SBP,24 h-DBP,d-SBP,d-DBP,n-SBP and n-DBP（ P〈0. 05）. Conclusion With the decline of renal function in patients with CKD,their hypertension increase and non- dipper and reversed dipper BP patterns take the majority,and circadian rhythm appears at the early stage of CKD; systolic and diastolic blood pressure increase with the elevation of urine microalbum

关 键 词：慢性肾脏病 血压监测 便携式 昼夜节律 

分 类 号：R692[医药卫生—泌尿科学] R544[医药卫生—外科学]