CAJ | 학술논문

目的探讨“亚临床”糖尿病肾病患者24 h动态血压变化规律.方法选取190例2型糖尿病患者,根据估算的肾小球滤过率(eGFR)水平分为肾小球高滤过率组和肾小球滤过率正常组,并以尿白蛋白水平再进行分组,分析各组动态血压、血压昼夜节律、平滑指数等变化规律.结果 (1)随尿白蛋白增加,2型糖尿病患者24 h、白昼及夜间的收缩压和舒张压均逐渐升高(P＜0.05),24 h收缩压标准差和变异系数逐渐升高,收缩压及舒张压平滑指数逐渐降低(P＜0.05)；(2)尿蛋白正常的肾小球高滤过率组患者已经开始出现血压节律异常,且随24 h尿白蛋白增加,夜间收缩压及舒张压下降百分率均逐渐降低(P＜0.05),而在微量白蛋白尿基础上,一旦发展为大量白蛋白尿,有85.7％患者失去正常血压节律.结论 “亚临床”糖尿病肾病患者存在血压昼夜节律异常和血压变异性增大.
목적 탐토“아림상”당뇨병신병환자24 h동태혈압변화규률.방법 선취190례2형당뇨병환자,근거고산적신소구려과솔(eGFR)수평분위신소구고려과솔조화신소구려과솔정상조,병이뇨백단백수평재진행분조,분석각조동태혈압、혈압주야절률、평활지수등변화규률.결과 (1)수뇨백단백증가,2형당뇨병환자24 h、백주급야간적수축압화서장압균축점승고(P＜0.05),24 h수축압표준차화변이계수축점승고,수축압급서장압평활지수축점강저(P＜0.05)；(2)뇨단백정상적신소구고려과솔조환자이경개시출현혈압절률이상,차수24 h뇨백단백증가,야간수축압급서장압하강백분솔균축점강저(P＜0.05),이재미량백단백뇨기출상,일단발전위대량백단백뇨,유85.7％환자실거정상혈압절률.결론 “아림상”당뇨병신병환자존재혈압주야절률이상화혈압변이성증대.
Objective To investigate the change of 24 h ambulatory blood pressure in patients with subclinical diabetic nephropathy.Methods A total of 190 type 2 diabetic patients were divided into 2 groups according to estimated glomerular filtration rate (eGFR):glomerular hyperfiltration (eGFR ≥ 120 ml · min-11.73 m-2,n =65),normal glomerular filtration rate (90 ≤ eGFR＜ 120 ml · min-1 · 1.73 m-2,n =125).The groups were further divided by means of 24-hour urinary albuminuria.The variation in the ambulatory blood pressure,the circadian rhythm of blood pressure,the smoothness index of blood pressure in each group were analyzed.Results (1) Along with the increasing microalbuminuria,24-hours,diurnal,and night systolic and diastolic blood pressure increased progressively in the diabetic patients (P＜0.05),24-hours standard deviation and coefficient variation of systolic blood pressure increased,and smoothness index of systolic and diastolic blood pressure decreased progressively (P＜0.05).(2) In the patients with glomerular hyperfiltration but normal albuminuria,the incidence of abnormal blood pressure rhythmicity began to increase; and that of lowering of systolic and diastolic blood pressure during night became less evident along with increasing microalbuminuria (P ＜ 0.05).With the progression of microalbuminuria to macroalbuminuria,85.7％ patients lost normal blood pressure rhythmicity.Conclusion Abnormal circadian rhythm of blood pressure and increased variation in blood pressure occur in patients with "subclinical" diabetic nephropathy.