原发性高血压患者血压昼夜节律对肾功能损害的相关性研究

Study on the relationship between the circadian rhythm and renal injury in patients with primary hypertension

关键词:  原发性高血压  血压昼夜节律  肾脏损伤  尿微量白蛋白

Key words:  primary hypertension  Bp circadian rhythm  renal injury  urine mAIb

摘要:

目的　观察原发性高血压病患者血压昼夜节律对肾功能损伤的影响。方法　对171例轻中度原发性高血压病患者根据夜间平均血压较日间平均血压下降的幅度，分为年龄、性别无明显差异的杓型和非杓型两个组。应用24 h动态血压监测和24 h尿微量白蛋白及肾功能生化测定，观察比较昼夜节律对肾功能损伤的影响。结果　两组患者24 h SBP和DBP、日间SBP和DBP的血压平均值比较，差异无显著性意义（P>0.05）；夜间SBP和DBP的血压平均值比较差异有显著性意义（P<0.05）；夜间下降率比较差异有显著性意义（P<0.01），杓型组与非杓型组分别为收缩压下降率（13.29±4.21）%、（4.05±3.64）%，舒张压下降率（14.50±3.56）%、（2.63±3.61）%； 24 h尿微量白蛋白差异有显著性意义（P<0.01），杓型组与非杓型组分别为（87.97±12.96）mg/24 h和（110.10±27.21）mg/24 h；血压夜间下降率与尿蛋白的分泌呈负相关；血肌酐、血尿素氮杓型组与非杓型组无明显差异。结论　原发性高血压病患者昼夜节律与高血压性肾脏损伤密切相关。

Abstract:

Objective 　To observe the impact Bp circadian rhythm changes on renal injury in patients with Primary Hypertension.　Methods 　A total of 171 cases with mild-moderate hypertension were divided into arytenoid group and non-arytenoid group which were on significant differences in age and gender, according to the decline rate of night average pressure below average daytime pressure. Applied 24 h ambulatory blood pressure monitoring,24 hour urine mAIb and renal function biochemical measurements to comparing the influence of Bp circadian rhythm to renal injure in two group patients.　Results 　There was no distinct differences in 24 h SBP and DBP or daytime average SBP and DBP (P>0.05); there was notable differences in nighttime average SBP and DBP (P<0.01); there was notable differences in the rate of BP decrease in nighttime between two groups (P<0.01), the rate of SBP decrease in blood pressure in arytenoid group and non-arytenoid group were (13.29±4.21)% and (4.05±3.64)%, the rate of DBP decrease in blood pressure in arytenoid group and non-arytenoid group were (14.50±3.56)% and（2.63±3.61）% respectively; there was notable differences in 24 h urine mAIb (P<0.01), which in arytenoid group and non-arytenoid group were (87.97±12.96)mg/24 h and (110.10±27.21）mg/24 h;the rate of decline in nighttime and urinary protein secretion was negative correlated; there was no distinct difference in serum Cr and BUN between arytenoid group and non-arytenoid group. 　Conclusion 　Bp circadian rhythm changes in patients with Primary Hypertension closely related on hypertensive renal damage.