中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2012年
5期
350-354
,共5页
徐大民%吕继成%刘立军%师素芳%张宏
徐大民%呂繼成%劉立軍%師素芳%張宏
서대민%려계성%류립군%사소방%장굉
肾小球肾炎,IgA%血压节律%高血压%动态血压监测
腎小毬腎炎,IgA%血壓節律%高血壓%動態血壓鑑測
신소구신염,IgA%혈압절률%고혈압%동태혈압감측
Glomerulonephritis,IgA%Blood pressure rhythm%Hypertension%Ambulatory blood pressure monitoring
目的 探讨IgA肾病患者血压昼夜节律与临床病理指标的关系.方法 采用横断面调查研究.选择2009年3月至8月在IgA肾病数据库登记的原发性IgA肾病患者,收集临床病理资料,并通过动态血压监测IgA肾病患者血压昼夜节律情况.用(日间血压平均值-夜间血压平均值)/日间血压平均值判断血压昼夜节律状况.比较血压节律正常组及异常组的临床病理指标.结果 共93例患者完成动态血压监测并纳入分析.其中68例(73％)血压节律消失,在慢性肾脏病(CKD)1期、2期及3期以上组血压节律消失的比例分别70％、70％及81％,3组间差异无统计学意义(P=0.587).非勺型血压在血压正常组与高血压组比例分别为69％和77％(P=0.373).血压节律消失与年龄、性别、血压、蛋白尿、肾功能以及肾脏病理损伤程度无相关.在随访时间超过12个月的54例中,非勺型血压组eGFR下降速率虽快于勺型血压组,但差异无统计学意义(P=0.329)；在其中29例并发高血压患者中,非勺型血压组eGFR下降速率快于勺型血压组,且差异有统计学意义[(-6.79±11.58)比(-0.34±1.74)ml·min-1·(1.73 m2)-1·年-1,P=0.019].结论 IgA肾病早期即可出现明显的血压节律消失.IgA肾病伴高血压患者的血压节律消失可能是影响肾功能进展的危险因素.
目的 探討IgA腎病患者血壓晝夜節律與臨床病理指標的關繫.方法 採用橫斷麵調查研究.選擇2009年3月至8月在IgA腎病數據庫登記的原髮性IgA腎病患者,收集臨床病理資料,併通過動態血壓鑑測IgA腎病患者血壓晝夜節律情況.用(日間血壓平均值-夜間血壓平均值)/日間血壓平均值判斷血壓晝夜節律狀況.比較血壓節律正常組及異常組的臨床病理指標.結果 共93例患者完成動態血壓鑑測併納入分析.其中68例(73％)血壓節律消失,在慢性腎髒病(CKD)1期、2期及3期以上組血壓節律消失的比例分彆70％、70％及81％,3組間差異無統計學意義(P=0.587).非勺型血壓在血壓正常組與高血壓組比例分彆為69％和77％(P=0.373).血壓節律消失與年齡、性彆、血壓、蛋白尿、腎功能以及腎髒病理損傷程度無相關.在隨訪時間超過12箇月的54例中,非勺型血壓組eGFR下降速率雖快于勺型血壓組,但差異無統計學意義(P=0.329)；在其中29例併髮高血壓患者中,非勺型血壓組eGFR下降速率快于勺型血壓組,且差異有統計學意義[(-6.79±11.58)比(-0.34±1.74)ml·min-1·(1.73 m2)-1·年-1,P=0.019].結論 IgA腎病早期即可齣現明顯的血壓節律消失.IgA腎病伴高血壓患者的血壓節律消失可能是影響腎功能進展的危險因素.
목적 탐토IgA신병환자혈압주야절률여림상병리지표적관계.방법 채용횡단면조사연구.선택2009년3월지8월재IgA신병수거고등기적원발성IgA신병환자,수집림상병리자료,병통과동태혈압감측IgA신병환자혈압주야절률정황.용(일간혈압평균치-야간혈압평균치)/일간혈압평균치판단혈압주야절률상황.비교혈압절률정상조급이상조적림상병리지표.결과 공93례환자완성동태혈압감측병납입분석.기중68례(73％)혈압절률소실,재만성신장병(CKD)1기、2기급3기이상조혈압절률소실적비례분별70％、70％급81％,3조간차이무통계학의의(P=0.587).비작형혈압재혈압정상조여고혈압조비례분별위69％화77％(P=0.373).혈압절률소실여년령、성별、혈압、단백뇨、신공능이급신장병리손상정도무상관.재수방시간초과12개월적54례중,비작형혈압조eGFR하강속솔수쾌우작형혈압조,단차이무통계학의의(P=0.329)；재기중29례병발고혈압환자중,비작형혈압조eGFR하강속솔쾌우작형혈압조,차차이유통계학의의[(-6.79±11.58)비(-0.34±1.74)ml·min-1·(1.73 m2)-1·년-1,P=0.019].결론 IgA신병조기즉가출현명현적혈압절률소실.IgA신병반고혈압환자적혈압절률소실가능시영향신공능진전적위험인소.
Objective To investigate the blood pressure circadian rhythm in patients with IgA nephropathy by ambulatory blood pressure monitoring and explore its role in the disease progression. Methods A cross sectional study was carried out.Blood pressure rhythm was studied by ambulatory 24-hour monitoring with a portable oscillometric recorder in selected patients with primary IgA nephropathy.The term "dipper" was described as blood pressure during night dropped at least 10％ below daytime blood pressure.The term "non-dipper" referred to those in whom the nocturnal decline in blood pressure was less than 10％.Clinicopathological indices between dipper and non-dipper groups were compared. Results Ninety-three patients completed ambulatory blood pressure monitoring among whom 68 (73％) patients were non-dipper.The frequency of non-dipper was 70％,70％ and 81％ in the patients at chronic kidney disease stage 1,2 and 3 or more.The frequency did not differ among these three group patients (P=-0.587).77％ of patients with hypertension and 69％ of patients with normotension were non-dipper (P=0.373).The disappearance of blood pressure circadian rhythm in IgA nephropathy was not influenced by age,gender,blood pressure,proteinuria,renal function and renal pathology lesions.Among the patients who were followed up regularly for more than 12 months (n=54),patients in the dipper group had a trend of slower eGFR decline rate than those in non-dipper group albeit the difference was not significant (P=0.329).Subgroup analysis revealed that in patients with hypertension and non-dipper (n=29),the eGFR decline rate was much faster than that in dipper group[(-6.79±11.58 )vs (-0.34±1.74) ml ·min-1 ·(1.73 m2)-1·year-1,P=0.019]. Conclusions Most patients with IgA nephropathy present disappearance of blood pressure circadian rhythm,even among those at an early stage or without hypertension.The loss of blood pressure rhythm may be associated with a rapid renal function decline rate in those with hypertension.
