糖尿病肾脏病合并高血压患者昼夜血压节律变化与脂代谢、内皮功能的相关性研究  

Study on the correlation between changes of circadian rhythm of blood pressure,lipid metabolism and endothelial function in patients with diabetes kidney disease complicated with hypertension

作　　者：李桂霞 翟晓丽[1] 黄艺 谢华[1] 戴泽亮[1] 黄磊[1] 岳淑俊 LI Gui-xia;ZHAI Xiao-li;HUANG Yi(Department of Nephrology,The Second People’s Hospital of Lanzhou,Lanzhou 730046,China.)

机构地区：[1]兰州市第二人民医院肾病科,兰州730046

出　　处：《中国处方药》2023年第6期1-4,共4页Journal of China Prescription Drug

基　　金：兰州市卫生健康科技发展计划项目(2019-009)

摘　　要：目的观察糖尿病肾脏病(diabetes kidney disease,DKD)伴高血压患者昼夜血压节律、内皮功能、血脂的水平变化,探讨昼夜血压节律改变是否与肾功能、内皮功能、脂代谢有关。方法选取诊断为DKD伴有高血压患者300例作为研究对象(按照昼夜血压节律改变分为非杓型组126例、反杓型组94例、杓型组80例),监测24 h动态血压,检测TG、HDL-C、LDL-C、TC、NO、ET-1水平。通过统计学处理分析昼夜血压节律改变与肾功能分期、血脂、内皮功能的相关性。结果300例患者中杓型血压、反杓型血压、非杓型血压占比分别为26.67%、31.33%、42.00%。三组患者LDL-C、HDL-C、TC、TG比较差异无统计学意义(P>0.05)。随着DKD分期递增,24 h SBP、dSBP、dDBP、nSBP、24 h SCV、24 h DCV、dSCV、dDCV、nSCV亦呈递增趋势,差异具有统计学意义(P<0.05)。与杓型组相比,非杓型组和反杓型组患者的血清NO水平减低,ET-1水平升高,差异有统计学意义(P<0.05)。且非杓型、反杓型组患者的血压与血清中ET-1水平呈正相关,与NO水平呈负相关,差异有统计学意义(P<0.05)。结论糖尿病肾脏病合并高血压患者血压昼夜节律异常中非杓型血压类型所占比例最高,昼夜血压节律变化与脂代谢无关,而与肾功能减退及内皮功能障碍存在相关性。Objective To observe the changes of circadian rhythm of blood pressure,endothelial function and blood lipid levels in patients with diabetic kidney disease(DKD)and hypertension,and to explore whether circadian rhythm of blood pressure changes are related to renal function,endothelial function and lipid metabolism.Methods A total of 300 patients diagnosed with DKD and hypertension were selected as subjects.According to the circadian rhythm of blood pressure,they were divided into non-dipper group(126 cases),reverse-dipper group(94 cases)and dipper group(80 cases).24-hour ambulatory blood pressure monitoring(24 h ABPM),Serum total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),nitric oxide(NO),and endothelin-1(ET-1)were recorded.The correlation between circadian rhythm of blood pressure changes and renal function stage,blood lipid and endothelial function was analyzed by statistical analysis.Results The proportions of dipper blood pressure,reverse-dipper blood pressure and non-dipper blood pressure in 300 patients were 26.67%,31.33%and 42.00%,respectively.There was no significant difference in LDL-C,HDL-C,TC and TG among the three groups(P>0.05).With the increase of DKD stage,the 24-hour average systolic blood pressure(24 h SBP),daytime average systolic blood pressure(dSBP),average daytime diastolic blood pressure(dDBP),nighttime average systolic blood pressure(nSBP),24 h systolic blood pressure coefficient of variation(24 hSCV),24 h diastolic blood pressure coefficient of variation(24 hDCV),daytime systolic blood pressure coefficient of variation(dSCV),daytime diastolic blood pressure coefficient of variation(dDCV)and nighttime systolic blood pressure coefficient of variation(nSCV)also showed an increasing trend,and the differences were statistically significant(P<0.05).Compared with the dipper group,the serum NO level in the non-dipper group and the reverse-dipper group was decreased,while the ET-1 level was increased,and the differences wer

关 键 词：糖尿病肾脏病 高血压 内皮功能 血压变异性 

分 类 号：R544.1[医药卫生—心血管疾病] R587.2[医药卫生—内科学] R692.9[医药卫生—临床医学]