昼夜血压节律异常对扩张型心肌病患者预后的影响  

Effects of abnormal circadian rhythm of blood pressure on prognosis of patients with dilated cardiomyopathy

作　　者：原琳[1] 田轶伦[1] 聂绍平[1] 

机构地区：[1]首都医科大学附属北京安贞医院急诊危重症中心,北京100020

出　　处：《中国循证心血管医学杂志》2017年第5期545-549,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家国际科技合作专项(2015DFA30160);北京市医管局重点医学发展计划(ZYLX201710);北京市科委绿色通道专项(Z141100006014057)

摘　　要：目的探讨昼夜血压节律对非缺血性扩张型心肌病(NIDCM)的预后价值。方法本研究连续登记了106例自2011年1月~2015年2月间于北京安贞医院就诊的NIDCM患者。根据夜间血压下降程度(%NBPF),将所有患者分为3组:杓型组(%NBPF≥10)23例,非杓型组(0≤%NBPF<10)61例,夜间血压上升组(上升组)(%NBPF<0)22例。观察比较患者一般情况,动态血压监测指标,并进行生存分析及探讨昼夜节律性血压模型的决定因素。结果上升组的患者血清肌酐水平最高[杓型:(0.78±0.20)mg/dl vs.非杓型组(0.85±0.21)mg/dl vs.上升组(0.99±0.23)mg/dl;P=0.006]。在存活率分析上来看,夜间血压上升患者心脏相关的死亡率最高(10g-rank,P=0.001),是独立的心脏相关死亡的预测因子(风险比,12.6;95%CI:1.76~253;P=0.01)。多变量分析显示24 h尿(24h U-NE)去甲肾上腺素水平和血清肌酐水平中都是%NBPF独立决定因子(调整后R2=0.20;24h U-NE,P=0.0001;血清肌酐,P=0.04)。结论夜间血压上升与非缺血性扩张型心肌病的不良预后有联系,评价昼夜血压节律简况可能会对非缺血性扩张型心肌病患者风险分层有较好的帮助。Objectives An abnormal circadian blood pressure （BP） profile is considered a risk factor for cardiovascular disease. However, its significance in heart failure patients with nonischemic etiology is unknown. Herein, we investigated the prognostic value of a circadian BP profile in patients with nonischemic dilated cardiomyopathy （NIDCM）. Methods We enrolled 106 NIDCM patients （74 males, mean age 52.7 years）. The percent nighttime BP fall （%NBPF） was defined using ambulatory BP monitoring as a percent decrease in mean systolic BP in nighttime from daytime. All patients were divided into three groups： dipper （%NBPF≥10）, nondipper （0≤%NBPF〈10）, and riser （%NBPF〈0）. Results Riser patients had the highest serum creatinine levels （dipper, 0.78±0.20 mg/dl; non-dipper, 0.85±0.21 mg/dl; riser, 0.99±0.23 mg/dl; P=0.006）. In survival analysis, riser patients had the highest cumulative cardiac-related deaths （log-rank, P=0.001）, which was an independent predictor of cardiac related deaths （hazard ratio, 12.6; 95% confidence interval=1.76～253; P=0.01）. Multivariate analysis revealed that the norepinephrine level at 24-hour collected urine （24h U-NE） and the serum creatinine level were independent determinants of %NBPF （adjusted R^2=0.20; 24h U-NE, P=0.0001; serum creatinine, P=0.04）. Conclusions The riser profile was associated with poor prognosis of NIDCM, which may reflect impaired sympathetic nervous system activity. Evaluating the circadian BP profile may be useful for risk stratification in NIDCM patients.

关 键 词：扩张型心肌病 动态血压监测 昼夜节律 

分 类 号：R542.2[医药卫生—心血管疾病]