原发性高血压患者血清25羟基维生素D水平与血压变异性及昼夜节律的关系  

The relationships of serum 25-hydroxyvitamin D level with blood pressure variability and circadian rhythm in patients with essential hypertension

作　　者：张强[1] 王淑辉[1] 杨丽红[1] 杨蕊珂[1] 郑红梅[1] 

机构地区：[1]郑州大学第二附属医院心内科,河南郑州450014

出　　处：《中华高血压杂志》2016年第3期250-256,共7页Chinese Journal of Hypertension

摘　　要：目的探讨原发性高血压患者血清25羟基维生素D[25（OH）D]水平与血压变异性（BPV）及昼夜节律的相关性。方法检测389例未经治疗的原发性高血压患者的血清25（OH）D浓度,按血清25（OH）D水平将患者分为25（OH）D正常组（〉30nmol/L,89例）、25（OH）D轻度缺乏组（16~30nmol/L,120例）、25（OH）D重度缺乏组（〈16nmol/L,180例）,对所有患者行24h动态血压监测,记录24h、白天、夜间平均收缩压和舒张压值,比较25（OH）D水平与BPV及昼夜节律的关系。以标准差作为BPV指标。结果高血压患者中25（OH）D正常者占22.9%,轻度缺乏者占30.8%,重度缺乏者占46.3%;女性25（OH）D水平低于男性[（15.20±8.23）比（19.47±7.02）nmol/L,P〈0.05]。3组间24h平均收缩压（24hSBP）、白天平均收缩压（dSBP）、夜间平均收缩压（nSBP）、24h收缩压标准差（24hSSD）、24h舒张压标准差（24hDSD）、白天收缩压标准差（dSSD）、白天舒张压标准差（dDSD）、夜间收缩压标准差（nSSD）、夜间舒张压标准差（nDSD）、夜间收缩压和舒张压下降率的差异有统计学意义（均P〈0.05）;重度缺乏组24h平均舒张压（24hDBP）、白天平均舒张压（dDBP）、夜间平均舒张压（nDBP）较25（OH）D正常组及轻度缺乏组高（均P〈0.05）,后两组间的差异无统计学意义（P〉0.05）。Pearson相关分析显示,25（OH）D与24hSSD、24hDSD、dSSD、dDSD、nSSD、nDSD呈负相关（分别r=-0.583、-0.530、-0.520、-0.389、-0.463、-0.377）,与夜间收缩压和舒张压下降率呈正相关（r=0.308、r=0.336）,均P〈0.01。多元线性回归分析显示,25（OH）D是24hSSD（B=-0.227）、24hDSD（B=-0.193）、dSSD（B=-0.211）、dDSD（B=-0.119）、nSSD（B=-0.193）、nDSD（B=-0.136）及夜间收缩压和舒张压下降率（B=0.273、0.329）的影响因素（均P〈0.01）。结论血清25（OH）D可能是原发性高血压患者BPV及昼夜节律改变的影响因素。Objective To investigate the correlations of serum 25-hydroxyvitamin D [25（OH）D]level with blood pressure variability（BPV）and circadian rhythm in essential hypertensive patients. Methods Serum 25（OH）D concentrations were detected in 389 patients with untreated essential hypertension. According to the serum 25（OH）D level,all patients were divided into normal（〉30nmol/L,n=89）,mild deficiency（〈16-30nmol/L,n=120）and severe deficiency（16nmol/L,n=180）group. The 24-hour ambulatory blood pressure monitoring was performed on all patients. The mean systolic and diastolic blood pressure in the periods of 24-hour,daytime and nighttime and the corresponding standard deviations（as BPV）were recorded. The relationships of the level of serum25（OH）D with BPV and circadian rhythm were analyzed. Results Among these patients with hypertension,those with normal 25（OH）D level,mild 25（OH）D deficiency,severe 25（OH）D deficiency accounted for 22.9%,30.8%,46.3%,respectively. The mean concentration of 25（OH）D was lower in female than that in male[（15.20±8.23）vs（19.47±7.02）nmol/L,P〈0.05]. Among the 3groups,there were statistical differences in mean 24-hour systolic blood pressure（24hSBP）,mean daytime systolic blood pressure（dSBP）,mean nighttime systolic blood pressure（nSBP）,24-hour systolic blood pressure standard deviation（24hSSD）,24-hour diastolic blood pressure standard deviation（24hDSD）,daytime systolic blood pressure standard deviation（dSSD）,daytime diastolic blood pressure standard deviation（dDSD）,nighttime systolic blood pressure standard deviation（nSSD）,nighttime diastolic blood pressure standard deviation（nDSD）and the decline rate of nighttime systolic and diastolic blood pressure（all P〈0.05）. Compared with normal 25（OH）D group and mild 25（OH）D deficiency group,mean 24-hour diastolic blood pressure（24hDBP）,mean daytime diastolic blood pressure（dDBP）,mean nighttime diastolic blood pressure（nDBP）were higher i

关 键 词：原发性高血压 血清25羟基维生素D 血压变异性 血压昼夜节律 

分 类 号：R544.11[医药卫生—心血管疾病]