高血压患者肾功能与血压变异性的关系  

Relationship between renal function and blood pressure variability in hypertensive patients

作　　者：吴慧君 余意君[1] 徐艳玲 顾力 郑伟 周志云 顾晔[2] WU Huijun;YU Yijun;XU Yanling;GU Li;ZHENG Wei;ZHOU Zhiyun;GU Ye(Department of ECG Science,Wuhan Fourth Hospital,Wuhan 430033,China)

机构地区：[1]武汉市第四医院心电生理科,武汉 430033 [2]武汉市第四医院心内科,武汉 430033

出　　处：《实用医学杂志》2020年第5期639-644,共6页The Journal of Practical Medicine

基　　金：武汉市卫计委科研基金资助项目(编号:WX16D24)。

摘　　要：目的探讨高血压患者肾功能与血压变异性(BPV)之间的关系。方法对2017年5月至2018年11月住院的高血压病患者根据肾小球滤过率(eGFR)[mL/(min·1.73 m^2)],分为性别、年龄相匹配的三组:eGFR≥90 mL/(min·1.73 m^2)组,60 mL/(min·1.73 m^2)≤eGFR<90 mL/(min·1.73 m^2)组和eGFR<60 mL/(min·1.73 m^2)组,每组各61例,对三组患者eGFR与BPV之间的关系进行分析。结果(1)eGFR<60 mL/(min·1.73 m^2)组的尿素氮、肌酐、eGFR和肾病史的比例均高于60 mL/(min·1.73 m^2)≤eGFR<90 mL/(min·1.73 m^2)组和eGFR≥90 mL/(min·1.73 m^2)组(P<0.05);eGFR<60 mL/(min·1.73 m^2)组的冠心病史的比例高于eGFR≥90 mL/(min·1.73 m^2)组(P<0.05);60 mL/min·1.73 m^2)≤eGFR<90 mL/(min·1.73 m^2)组的eGFR、肾病史的比例高于eGFR≥90 mL/(min·1.73 m^2)组(P<0.05)。(2)eGFR<60 mL/(min·1.73 m^2)组的24 h、白天脉压差平均值高于60 mL/(min·1.73 m^2)≤eGFR<90 mL/(min·1.73 m^2)组(P<0.05);eGFR<60 mL/(min·1.73 m^2)组的白天收缩压变异系数高于eGFR≥90 mL/(min·1.73 m^2)组(P<0.05)。(3)Logistic回归分析显示,校正性别、年龄和β受体阻滞剂的影响后,24 h收缩压变异系数和白天收缩压变异系数增高是高血压病患者发生肾功能不全的危险因素。结论高血压患者eGFR水平与BPV密切相关,肾功能受损严重的高血压病患者,BPV增加。Objective To explore the relationship between renal function and blood pressure variability in hypertensive patients.Methods Hypertensive patients matched gender and age were divided intoeGFR≥90 group,60≤eGFR<90 group and eGFR<60 group(n=61 each)according to glomerular filtration rate(eGFR)[mL/(min·1.73 m^2)]from May 2017 to November 2018 in our hospital.The relationship between eGFR and BPV was analyzed among the three groups.Results(1)Blood urea nitrogen,creatinine,eGFR and proportion of history of nephropathy were significantly higher in the eGFR<60 group than those of the 60≤eGFR<90 group and eGFR>90 group(P<0.05).The proportion of history of coronary heart disease was significantly higher in the eGFR<60 group than that of the eGFR≥90 group(P<0.05);eGFR and proportion of history of nephropathy were significantly higher in the 60≤eGFR<90 group than that of the eGFR≥90 group(P<0.05).(2)24-hour and daytime mean pulse pressure difference were significantly higher in the eGFR<60 group than those of the 60≤eGFR<90 group(P<0.05).The daytime systolic blood pressure coefficient of variation was significantly higher in the eGFR<60 group than that of the eGFR≥90 group(P<0.05).(3)Logistic regression analysis showed that higher 24 h systolic blood pressure coefficient of variation and daytime systolic blood pressure coefficient of variation were risk factors for hypertensive patients with renal insufficiency after adjusting for gender,age and beta-blockers.Conclusion The level of eGFR is closely related to blood pressure variability in hypertensive patients.Hypertensive patients with severe renal impairment have increased blood pressure variability.

关 键 词：高血压病 肾小球滤过率 血压变异性 

分 类 号：R544.1[医药卫生—心血管疾病]