维持性血液透析患者血压晨峰和心脑血管疾病关系的临床观察  

Relationship between morning blood pressure surge and cardiocerebrovascular vents in maintenance hemodialysis patients

作　　者：蒲超[1] 白佳柠 袁锦[1] 陈永忠[1] 朱再志 许志忠[1] 

机构地区：[1]四川省眉山市人民医院肾内科,620010

出　　处：《临床肾脏病杂志》2016年第11期677-680,共4页Journal Of Clinical Nephrology

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者血压晨峰与心脑血管疾病发生的关系。方法选取四川省眉山市人民医院肾内科242例MHD患者采用动态血压监测仪记录24 h血压,根据血压晨峰分为血压晨峰组(44例)和非血压晨峰组(198例)。采集2组患者相关的研究数据,记录发生的心脑血管疾病,随访3年,比较2组患者一般资料、心脑血管疾病发生率及病死率。结果①2组患者24 h平均收缩压(24hSBP)比较差异有统计学意义(P<0.05),血白蛋白、血红蛋白、血钙、血磷和24 h平均舒张压(24hDBP)比较差异无统计学意义(P>0.05)。②血压晨峰组的24hSBP、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、QT离散度、左心室质量指数分别为(152±14)mmHg、(158±10)mmHg、(124±12)mmHg、(56.2±14.6)、(132.8±4.0)g/m^2,与非血压晨峰组比较差异有统计学意义(P<0.05);晨起时2hSBP、24 h平均脉压(24hPP)、动脉内膜-中膜厚度分别为(168±17)mmHg、(62.5±12.6)mm-Hg、(1.18±0.32)mm,与非血压晨峰组比较,差异有统计学意义(P<0.01);2组患者24hDBP、dDBP、nDBP、夜间最低DBP和晨起时2hDBP比较,差异无统计学意义(P>0.05)。③血压晨峰组的心脑血管疾病发生率(63.6%)及病死率(27.3%)显著高于非血压晨峰组(22.7%,8.1%)(P<0.01)。结论 MHD患者存在血压晨峰现象,血压晨峰与MHD患者心脑血管疾病密切相关,可能是MHD患者心脑血管疾病的独立危险因素。Objective To investigate the correlation between morning blood pressure surge （MBPS） and cardiocerebrovascular events in maintenance hemodialysis （MHD） patients. Methods Ambulatory blood pressure monitoring was done in 242 MHD patients admitted to Department of Nephrology, Meishan People＇s Hospital. The patients were classified as MBPS group （n = 44） and non-MBPS group （n = 198） based on the MBPS. Related clinical trial data were collected： 24hSBP, 24hDBP, 24hPP, dSBP, dDBP, nSBP, nDBP, the lowest SBP at night, the lowest DBP at night, 2hSBP after getting up in the morning, 2hSBP after getting up in the morning, the left ventricular mass index （LVMI）, the intima-media thickness （IMT）, QT dispersion （QTd）. The patients were followed up for 3 years, and cardiocerebrovaseular diseases were recorded. General information, mortality and the incidence of cardiocerebrovascular diseases were compared between the two groups. Results （1） There was significant difference in 24 hSBP between two groups （P〉0. 05）, but no significant differences were found in Alb, Hb, Ca, P and 24hDBP （P〉0. 05 for all） ; （2） 24 hSBP, dSBP, nSBP, QTd and LVMI in MBPS group were （152 ± 14） mmHg, （158 ± 10） mmHg, （124 ＋ 12） mmHg, （56. 2± 14. 6） and （132. 8± 4. 0） g/m2 respectively, significantly different from those in the nonMBPS group （P〈0. 05 for all）. 24hPP and 2hSBP after getting up in the morning, and IMT were （168 ± 17） mmHg, （62. 5 ± 12. 6） mmHg, and （1.18 ± 0. 32） mm in MBPS group were higher than those in non-MBPS group （P〈0. 01）, and there was no significant difference between the two groups in 24hDBP, dDBP, nDBP, minimum DBP and early morning 2hDBP （P〉0. 05） ; （3） The incidence of cardiocerebrovaseular diseases （63. 6 %） and mortality （27. 3%） in MBPS group were significantly increased compared to non-MBPS group （22.7% and 8. 1%） （P〈0. 01）. Conclusions MBPS exists in MHD patients. MBPS closely correlates w

关 键 词：维持性血液透析 血压晨峰 心脑血管疾病 动态血压监测 

分 类 号：R692.5[医药卫生—泌尿科学]