808例原发性肾小球疾病患者动态血压特点及其与靶器官损伤的关系  

Features of ambulatory blood pressure in 808 patients with primary glomerular disease and their correlation with target organ damage

作　　者：黎燕[1] 张俊[1] 马欣欣[1] 彭晖[1] 成彩联[1] 王成[1] 

机构地区：[1]中山大学附属第三医院肾脏内科,广州510630

出　　处：《中华肾脏病杂志》2016年第4期241-246,共6页Chinese Journal of Nephrology

基　　金：中山大学附属第三医院杰出青年后备人才培养计划（[2010]118）

摘　　要：目的探讨原发性肾小球疾病患者的动态血压特点及其与靶器官损伤的关系。方法选择2010年5月至2015年5月期间在中山大学附属第三医院肾脏内科住院的原发性肾小球疾病患者为研究对象，使用携带式动态血压计监测动态血压，采用彩色超声仪评价心脏结构和功能改变，并收集人1：I学及实验室数据等资料。多重线性回归法分析影响患者动态血压水平的相关因素，多因素logistic回归法分析动态血压与靶器官损伤的相关因素。结果808例原发性肾小球疾病患者入选。随着肾功能的下降，患者24h收缩压（SBP）、白天SBP及夜间SBP值逐渐增高（r自分别为O．547、O．538、0．546，均Pc0．01）；与CKD1—3期组相比，CKD4～5期组患者勺型血压发生率降低，反勺型血压模式发生率升高（Pt0．05）。多因素logistic回归分析结果显示，血红蛋白、血尿酸、24hSBP（OR=I．069，Pc0．01）、血白蛋白、全段甲状旁腺激素（iPTH）、钙磷乘积与肾功能受损相关；估算肾小球滤过率（eGFR）、年龄、夜间SBP（OR=1．033，P〈0．01）、性别、iPTH与左心室肥厚相关；夜间SBP（OR=1．019，P〈0．01）、eGFR、性别、血糖与左心室舒张功能减退相关。结论随着肾功能的下降，原发性肾小球疾病患者24hSBP、夜间SBP升高，勺型血压模式发生率降低，反勺型血压模式发生率升高。动态血压水平与靶器官损伤相关。Objective To explore the features of ambulatory blood pressure in patients with primary glomerular disease and their correlation with target organ damage （TOD）. Methods Patients with primary glomerular disease admitted to the Nephrology Department, the Third Affiliated Hospital of Sun Yat- sen University from May 2010 to May 2015 were enrolled. Ambulatory blood pressure monitoring （ABPM）, clinical BP, uhrasonographic assessment and other clinical data were collected. Univariate and multivariate analyses were used to ascertain the relationship between ABPM results and clinical parameters. Results 808 patients were enrolled. Patients turned out to have a higher level of 24-hour systolic blood pressure （SBP）, day-time SBP, and night-time SBP as their kidney function declined （r,=0.547, 0.538, 0.546, P 〈 0.01）. Compared with that in CKD 1-3, Tile percentage of dipper blood pressure pattern decreased and that of reversed dipper blood pressure pattern increased in CKD stage 4- 5 （P 〈 0.05）. A higher level of 24 h SBP was independently associated with kidney function damage （OR=1.069, P 〈 0.01）, and a higher level of night-time SBP was an independent factor affecting left ventricular hypertrophy （OR=1.033, P 〈 0.01） and reduction of diastolic function of left ventricle （OR=l.019, P 〈 0.01） after multivariate logistic regression analyses. Conclusion With advancing CKD stage, the level of 24 h SBP, day-time SBP, and night-time SBP was higher and the percentage of reversed dipper blood pressure pattern was higher. The parameters of ABPM were closely related to renal damage and cardiovascular injuries.

关 键 词：1血压监测 便携式 高血压 肾小球疾病 原发性 靶器官损伤 

分 类 号：R692.6[医药卫生—泌尿科学]