IgA肾病伴高血压患者血压节律异常与肾脏结构和功能损伤的关系  

Circadian rhythm of blood pressure is associated with renal structure damage and function in IgA nephropathy with hypertension

作　　者：肖菲[1] 戴欢子[1] 张建国[1] 李开龙[1] 何娅妮[1] 林利容[1] 

机构地区：[1]第三军医大学第三附属医院野战外科研究所肾内科,重庆400042

出　　处：《临床内科杂志》2017年第9期608-611,共4页Journal of Clinical Internal Medicine

基　　金：国家十二五、十三五科技支撑计划课题（2013BA109805、2015BA112806）

摘　　要：目的分析IgA肾病伴高血压患者血压昼夜节律异常与肾脏损伤的关系。方法根据血压昼夜节律情况，将571例Iga肾病伴高血压患者分为杓型高血压组和非杓型高血压组，并对其临床及肾脏病理资料进行分析，。肾脏病理损伤采用IgA肾病牛津分型。结果571例IgA肾病患者中，血压昼夜节律异常占71．6％。非杓型高血压患者BMI、血胱抑素C、血肌酐（Scr）、尿酸（UA）、尿N－乙酰β—D氨基葡糖苷酶（uNAG）、尿白蛋白／肌酐（UACR）明显高于杓型高血压组（P〈0．05），估算的肾小球滤过率（eGFR）低于杓型高血压组（P〈0．05）。非杓型高血压组肾组织损伤积分、肾小球硬化、缺血样改变、肾小管间质纤维化、肾脏血管病变程度较杓型组严重（P〈0．05）。多因素分析结果显示，血压昼夜节律异常与eGFR、UA、UACR、肾组织损伤积分、。肾间质纤维化、动脉硬化密切相关（P〈0．05）。结论血压昼夜节律异常在IgA肾病患者中极为常见。异常的血压昼夜节律可能会加重IgA肾病病理损伤和肾脏疾病进展。Objective To analyze the relationship between abnormal circadian rhythm of blood pressure and renal injury in patients with IgA nephropathy and hypertension. Methods Based on the circadian rhythm of blood pressure, 571 patients with IgA nephropathy accompanied with hypertension were divided into dipper hypertension group and non-dipper hypertension group. Clinical and renal histopathological data were analyzed. Renal histopathological injury was determined according to the Oxford classification of IgA nephropathy. Results In 571 patients with IgA nephropathy, abnormal blood pressure circadian rhythm accounted for 71.6%. The body mass index, serum cystatin C, serum creatinine（Ser） , uric acid （ UA ） , urinary urine N-Aeetyl-β-glucosaminidase （ uNAG ） , urinary alhumin/creatinine ratio （UACR） in patients with non-dipper hypertension were significantly higher than those in dipper hypertension group, and estimated glomerular filtration ratel（eGFR） was lower than that in dipper hypertension group. In the non-dipper hypertension group, the renal tissue injury score, glomerular sclerosis, ischemia, tubulointerstitial fibrosis and arcuate artery were significantly severer than those in dipper hypertension group（P 〈 0.05 ）. Muhiuariate analysis showed abnormal circadian rhythm of blood pressure was closely related to eGFR,UA,UACR,renal tissue injury score,renal interstitial fibrosis and atherosclerosis（P 〈0.05）. Conclusion Abnormal circadian rhythm of blood pressure is very common in patients with IgA nephropathy. Abnormal circadian rhythm of blood pressure may aggravate the pathological damage and kidney disease progression of IgA nephropathy.

关 键 词：IGA肾病 血压昼夜节律 肾脏组织损伤 

分 类 号：R586[医药卫生—内分泌]