肾脏局部肾素-血管紧张素系统与血压昼夜节律的关系研究  

Relationship between intrarenal renin-angiotensin system and circadian rhythm of blood pressure

作　　者：袁静[1] 王立立[2] 陈华[3] 王闪 倪艳辉[1] 金曼[4] 刘美霞[1] 郭艺芳[5] Yuan Jing;Wang Lili;Chen Hua;Wang Shan;Ni Yanhui;Jin Man;Liu Meixia;Guo Yifang(Cardiovascular Division 4,Hebei General Hospital,Shijiazhuang 050051,China;Cardiovascular Division 3,Hebei General Hospital,Shijiazhuang 050051,China;Cardiovascular Division 5,Hebei General Hospital,Shijiazhuang 050051,China;Neurology Department 4,Hebei General Hospital,Shijiazhuang 050051,China;Department of Geriatrics,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院心血管内四科,石家庄050051 [2]河北省人民医院心血管内三科,石家庄050051 [3]河北省人民医院心血管内五科,石家庄050051 [4]河北省人民医院神经内四科,石家庄050051 [5]河北省人民医院老年心内科,石家庄050051

出　　处：《中国心血管杂志》2022年第1期17-22,共6页Chinese Journal of Cardiovascular Medicine

基　　金：河北省医学科学研究课题计划(20190236)。

摘　　要：目的探讨肾脏局部肾素-血管紧张素系统(RAS)是否存在昼夜节律,及其与血压昼夜节律的关系。方法选择2018年3月至2019年3月在河北省人民医院就诊的原发性高血压(EH)患者104例,其血清肌酐(SCr)与估算的肾小球滤过率(eGFR)均正常。根据收缩压的昼夜节律类型,将患者分为杓型组37例、非杓型组35例和反杓型组32例,分别测量各组4个时间段(8:00-14:00、14:00-20:00、20:00-2:00、2:00-次日8:00)尿肾素(U-REN)和尿血管紧张素原(U-AGT)的含量。结果(1)U-REN的含量在20:00-2:00和2:00-次日8:00反杓型组和非杓型组均高于杓型组(均为P<0.05),且反杓型组较非杓型组升高更为明显(均为P<0.05);(2)U-AGT的含量在14:00-20:00、20:00-2:00和2:00-次日8:00反杓型组和非杓型组均高于杓型组(均为P<0.05),在20:00-2:00和2:00-次日8:00反杓型组高于非杓型组(均为P<0.05);(3)U-REN和U-AGT在杓型组各个时间段的含量比较,差异无统计学意义(均为P>0.05),非杓型组和反杓型组U-REN和U-AGT含量在20:00-2:00和2:00-次日8:00明显高于8:00-14:00和14:00-20:00(均为P<0.05),反杓型组更为显著(均为P<0.05)。结论U-AGT和U-REN在非杓型和反杓型EH患者中呈现昼低夜高,而在杓型EH患者中昼夜变化不明显。测量日间和夜间尿液中U-AGT和U-REN的含量可能将有助于判断肾脏局部RAS的激活程度,并进一步了解血压节律受损程度。Objective To investigate whether there is a circadian rhythm in the intrarenal reninangiotensin system,and its relation to the circadian rhythm of blood pressure.Methods From March 2018 to March 2019,104 patients with essential hypertension(EH)were admitted to the Hebei General Hospital,and the serum creatinine level and estimated glomerular filtration rate were normal.The patients were divided into dipper group(n=37),non-dipper group(n=35)and reverse dipper group(n=32),according to circadian rhythm of systolic blood pressure.Urinary renin(U-REN)and urinary angiotensinogen(U-AGT)were measured in each group at four time periods respectively(8:00-14:00,14:00-20:00,20:00-2:00,2:00-8:00 the next day).Results(1)The level of U-REN was higher in reverse dipper group and non-dipper group than that in dipper group at 20:00-2:00 and 2:00-8:00 periods(all P<0.05),and reverse dipper group was significantly higher than non-dipper group(all P<0.05).(2)The level of U-AGT was higher in reverse dipper group and non-dipper group than that in dipper group at 14:00-20:00,20:00-2:00 and 2:00-8:00 periods(all P<0.05),and reverse dipper group was higher than non-dipper group at 20:00-2:00 and 2:00-8:00 periods(all P<0.05).(3)There was no significant difference of U-REN and U-AGT in dipper group at each time period(all P>0.05).It was noted that U-REN and U-AGT in non-dipper group and reverse dipper group at 20:00-2:00 and 2:00-8:00 periods were significantly higher than those at 8:00-14:00 and 14:00-20:00 periods(all P<0.05).U-REN and U-AGT were especially higher in reverse dipper group(all P<0.05).Conclusions U-REN and U-AGT show circadian rhythms in reverse dipper group and non-dipper group,and the levels during nighttime are significantly higher than those during daytime.The intrarenal renin and angiotensinogen levels have no obvious circadian rhythm in dipper group.The measurement of U-REN and U-AGT during daytime and nocturnal urine may help to determine the degree of the intrarenal renin-angiotensin system activation and to furthe

关 键 词：肾 肾素-血管紧张素系统 高血压 昼夜节律 尿肾素 尿血管紧张素原 

分 类 号：R544.11[医药卫生—心血管疾病]