CAJ | 학술논문

目的：探讨高龄高血压患者白蛋白尿与血压节律异常的关系。方法选取2012年6月至2013年6月在北京友谊医院住院的70例高龄高血压患者，收集临床资料、尿白蛋白排泄率以及动态血压监测结果。根据尿检结果将其分为白蛋白尿组（n＝32）和非白蛋白尿组（n＝38）。比较两组之间的白昼平均收缩压（dSBP）和舒张压（dDBP）、夜间平均收缩压（nSBP）和舒张压（nDBP），以及夜间收缩压和舒张压下降率、血压变异曲线。结果白蛋白尿组与非白蛋白尿组间比较，年龄、性别、糖尿病发生率、超敏C反应蛋白、左室射血分数等方面均无明显差异（P＞0.05）。与非白蛋白尿组比较，白蛋白尿组患者估测肾小球滤过率（eGFR）明显下降（P＜0.05）。动态血压监测结果显示两组患者dSBP和dDBP均在正常范围，且无明显差异（P＞0.05），但白蛋白尿组nSBP明显升高（P＜0.01）。两组患者非杓型血压节律的发生率无显著差异，白蛋白尿组患者的反杓型曲线比例更高（P＜0.01）。结论夜间收缩压升高，即反杓型血压节律，与高龄高血压患者白蛋白尿和eGFR下降高度相关。
목적：탐토고령고혈압환자백단백뇨여혈압절률이상적관계。방법선취2012년6월지2013년6월재북경우의의원주원적70례고령고혈압환자，수집림상자료、뇨백단백배설솔이급동태혈압감측결과。근거뇨검결과장기분위백단백뇨조（n＝32）화비백단백뇨조（n＝38）。비교량조지간적백주평균수축압（dSBP）화서장압（dDBP）、야간평균수축압（nSBP）화서장압（nDBP），이급야간수축압화서장압하강솔、혈압변이곡선。결과백단백뇨조여비백단백뇨조간비교，년령、성별、당뇨병발생솔、초민C반응단백、좌실사혈분수등방면균무명현차이（P＞0.05）。여비백단백뇨조비교，백단백뇨조환자고측신소구려과솔（eGFR）명현하강（P＜0.05）。동태혈압감측결과현시량조환자dSBP화dDBP균재정상범위，차무명현차이（P＞0.05），단백단백뇨조nSBP명현승고（P＜0.01）。량조환자비표형혈압절률적발생솔무현저차이，백단백뇨조환자적반표형곡선비례경고（P＜0.01）。결론야간수축압승고，즉반표형혈압절률，여고령고혈압환자백단백뇨화eGFR하강고도상관。
Objective To investigate the correlation of albuminuria with ambulatory blood pressure pattern in the very old patients with hypertension. Methods Seventy very old hypertensive subjects admitted to Beijing Friendship Hospital from June 2012 to June 2013 were enrolled in this study. Their clinical data, urinary albumin excretion rate, ambulatory 24-hour blood pressure monitoring results were collected. The patients were divided into albuminuria group (n=32) and non-albuminuria group(n=38) according to the results of urinary test. Day systolic blood pressure(dSBP) and day diastolic blood pressure(dDBP), night systo1ic blood pressure(nSBP) and night diastolic blood pressure(nDBP) were compared between the 2 groups. Night blood pressure descend and blood pressure pattern were also observed in the 2 groups. Results There was no significant difference in the age, gender, diabetes incidence, high sensitivity C reactive protein, ejection fraction between the 2 groups(P>0.05). Estimated glomerular filtration rate(eGFR) was significantly lower in albuminuria group than in the non-albuminuria group(P<0.05). Ambulatory 24-hour blood pressure monitoring indicated that the dSBP and dDBP were normal in the 2 groups, without significant difference(P>0.05). The albuminuria group had significantly higher nSBP than the non-albuminuria group (P<0.01). There was no significant difference in the non-dipper blood pressure between the 2 groups, but the albuminuria group had higher rate of reversed dipper blood pressure(P<0.01). Conclusion Increased nSBP, that is, the reversed dipper blood pressure pattern, is closely related to albuminuria and decreased eGFR in the very old patients with hypertension.