2型糖尿病患者肾小管功能受损与动态血压节律的关系  

Association between ambulatory blood pressure rhythm and impaired renal tubular function in patients with type 2 diabetes

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

机构地区：[1]天津医科大学代谢病医院内分泌研究所国家卫生计生委激素与发育重点实验室天津市代谢性疾病重点实验室,300070

出　　处：《中华糖尿病杂志》2016年第8期478-482,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金面上项目（81470187、81273915）;天津市自然科学基金（14JCYBJC26200）

摘　　要：目的探讨2型糖尿病患者肾小管功能受损与动态血压节律的关系。方法收集2012年1月至2015年7月于天津医科大学代谢病医院住院、尿向蛋白正常的2型糖尿病患者412例，男性228例，女性184例，年龄（53±8）岁，根据肾小管功能检测分为肾小管功能正常组（288例）和肾小管功能受损组（124例）。检测生化指标、行24h动态血压监测。比较两组生化指标、平均血压、血压昼夜节律和血压变异性，Logistic回归分析肾小管功能受损的影响因素。结果（1）肾小管功能受损组预估肾小球滤过率（eGFR）及糖化血红蛋白（HbA1c）明显高于肾小管功能正常组[（131±24）比（109±13）ml／min，（8．0±2．41％LL（7．5±2．21％，t=12．147、2．058，均P〈0．051。（2）肾小管功能受损组24h收缩压变异系数和夜间收缩压下降百分率与肾小管功能正常组相比，差异有统计学意义[（8．9±2．7）％比（9．5±2．8）％，（11±5）kL（10±4）mmHg（1mmHg=0．133kPa），t=2．046、2．553，均P〈0．05]。（3）Logistic回归分析显示肾小管功能受损与eGFR、HbA1c呈正相关，与夜间收缩压下降百分率呈负相关（OR=I．645、1．597、0．736，均P〈0．05）。结论2型糖尿病患者肾小管功能受损较血压昼夜节律改变出现得更早。Objective To investigate the association between ambulatory blood pressure rhythm and impaired renal tubular function in patients with type 2 diabetes. Methods A total of 412 patients with type 2 diabetes and nonnoalbuminuria were included from January 2012 to July 2015, among which male were 228, thmale 184 and average age was （53±8） yrs. Patients were divided into normal renal tubular function group（288 cases） and impaired renal tubular function group（124 cases）. Biochemical indicators were detected and 24 h ambulatory blood pressure monitoring was performed. Biochemical indicators, mean blood pressure, the circadian rhythm of blood pressure and blood pressure variation were compared between the two groups. Logistic regression analysis was performed to evaluate risk factors on renal tubular function. Results The levels of estimated glomerular filtration rate （eGFR） and glycosylated hemoglobin （HbA,,,） in impaired renal tubular function group were significantly higher than that of normal renal tubular function group（（131±24） vs （109±13）ml/min, （8.0±2.4）% vs （7.5±2.2）%, t=12.147, 2.058, both P〈0.05）. Compared to normal renal tubular function group, 24 h systolic variation coefficient were significantly higher and the percentage of decreased systolic blood pressure at night was significantly lower in impaired renal tubular function group （（11±5）vs（10±4） mmHg（ 1 mmHg=0.133 kPa）, （8.9±2.7）% vs（9.5±2.8）%, t=2.046, 2.553, both P〈0.05）. Logistic regression analysis showed that renal tubular function impairement was positively related to eGFR and HbAi,, and negatively related to the percentage of decreased systolic blood pressure at night （0R=1.645, 1.597, 0.736, all P〈0.05）. Conclusion Renal tubular function impairement occurs earlier than the change of blood pressure circadian rhythm in patients with type 2 diabetes.

关 键 词：糖尿病 2型 肾小管功能受损 动态血压节律 

分 类 号：R544.1[医药卫生—心血管疾病]