中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2013年
1期
11-15
,共5页
王成%张俊%刘迅%李翠翠%叶增纯%彭晖%娄探奇
王成%張俊%劉迅%李翠翠%葉增純%彭暉%婁探奇
왕성%장준%류신%리취취%협증순%팽휘%루탐기
血压%血压监测,便携式%肾疾病,慢性
血壓%血壓鑑測,便攜式%腎疾病,慢性
혈압%혈압감측,편휴식%신질병,만성
Blood pressure%Blood pressure monitoring,ambulatory%Kidney disease,chronic
目的 探讨慢性肾脏病患者动态血压的特点、影响因素及与靶器官损害的关系.方法 以2010年5月至2012年5月中山大学附属第三医院肾内科慢性肾脏病患者540例为研究对象.以携带式动态血压计进行动态血压监测,同时测量尿蛋白等临床指标.用心脏超声评价心脏结构和功能改变；高频超声评价颈部血管中膜厚度及斑块情况.用单因素和多因素分析探讨动态血压监测结果与临床指标的关系.结果 63.9％患者血压模式为非勺型,36.1％患者为勺型.与勺型血压患者相比,非勺型血压患者的夜间/白天尿蛋白比例较高(0.51 ±0.29比0.42±0.21,P＜0.01),肾小球滤过率较低[(56.2±48.2)比(75.5±56.5) ml·min-1·(1.73 m2)-1,P＜0.01],血清胱抑素C较高[(2.8±2.0)比(2.1 ±2.0) mg/L,P＜0.01],颈部血管内中膜厚度较大[(0.7±0.3)比(0.6±0.2) mm,P＜0.01],左室质量指数较高[(53.7±23.2)比(45.1±16.3) g/m2,P＜ 0.01],舒张功能低下.夜间血压是慢性肾脏病患者的蛋白尿、肾小球滤过率、左室质量指数的独立预测指标.结论 非勺型血压模式是慢性肾脏病患者最常见的血压模式.夜间血压与患者的靶器官损伤密切相关.
目的 探討慢性腎髒病患者動態血壓的特點、影響因素及與靶器官損害的關繫.方法 以2010年5月至2012年5月中山大學附屬第三醫院腎內科慢性腎髒病患者540例為研究對象.以攜帶式動態血壓計進行動態血壓鑑測,同時測量尿蛋白等臨床指標.用心髒超聲評價心髒結構和功能改變；高頻超聲評價頸部血管中膜厚度及斑塊情況.用單因素和多因素分析探討動態血壓鑑測結果與臨床指標的關繫.結果 63.9％患者血壓模式為非勺型,36.1％患者為勺型.與勺型血壓患者相比,非勺型血壓患者的夜間/白天尿蛋白比例較高(0.51 ±0.29比0.42±0.21,P＜0.01),腎小毬濾過率較低[(56.2±48.2)比(75.5±56.5) ml·min-1·(1.73 m2)-1,P＜0.01],血清胱抑素C較高[(2.8±2.0)比(2.1 ±2.0) mg/L,P＜0.01],頸部血管內中膜厚度較大[(0.7±0.3)比(0.6±0.2) mm,P＜0.01],左室質量指數較高[(53.7±23.2)比(45.1±16.3) g/m2,P＜ 0.01],舒張功能低下.夜間血壓是慢性腎髒病患者的蛋白尿、腎小毬濾過率、左室質量指數的獨立預測指標.結論 非勺型血壓模式是慢性腎髒病患者最常見的血壓模式.夜間血壓與患者的靶器官損傷密切相關.
목적 탐토만성신장병환자동태혈압적특점、영향인소급여파기관손해적관계.방법 이2010년5월지2012년5월중산대학부속제삼의원신내과만성신장병환자540례위연구대상.이휴대식동태혈압계진행동태혈압감측,동시측량뇨단백등림상지표.용심장초성평개심장결구화공능개변；고빈초성평개경부혈관중막후도급반괴정황.용단인소화다인소분석탐토동태혈압감측결과여림상지표적관계.결과 63.9％환자혈압모식위비작형,36.1％환자위작형.여작형혈압환자상비,비작형혈압환자적야간/백천뇨단백비례교고(0.51 ±0.29비0.42±0.21,P＜0.01),신소구려과솔교저[(56.2±48.2)비(75.5±56.5) ml·min-1·(1.73 m2)-1,P＜0.01],혈청광억소C교고[(2.8±2.0)비(2.1 ±2.0) mg/L,P＜0.01],경부혈관내중막후도교대[(0.7±0.3)비(0.6±0.2) mm,P＜0.01],좌실질량지수교고[(53.7±23.2)비(45.1±16.3) g/m2,P＜ 0.01],서장공능저하.야간혈압시만성신장병환자적단백뇨、신소구려과솔、좌실질량지수적독립예측지표.결론 비작형혈압모식시만성신장병환자최상견적혈압모식.야간혈압여환자적파기관손상밀절상관.
Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease (CKD) patients.Methods A total of 540 CKD patients from May 2010 to May 2012 in our department were enrolled in this study.Ambulatory blood pressure monitoring was carried out.Blood pressure (BP),proteinuria and other clinical parameters were measured regularly.Ultrasonography was used to evaluate cardiac structure and function,carotid intima-media thickness and plaque.Univariate and multivariate analysis were used to examine the association between BP and clinical parameters.Results 63.9％ of CKD patients was non-dipper BP pattern,and 36.1％ was dipper BP pattern.As compared to dipper BP patients,those with non-dipper BP had higher ratio of nighttime/daytime proteinuria (0.51±0.29 vs 0.42±0.21,P ＜ 0.01),lower estimated glomerular filtration rate (eGFR) [(56.2±48.2) vs (75.5±56.5) ml· min 1 · (1.73 m2)-1,P ＜ 0.01],higher serum cystatin C[(2.8±2.0) mg/L vs (2.1±2.0) mg/L,P ＜ 0.01],higher left ventricular mass index [(53.7±23.2) vs (45.1± 16.3) g/m2,P ＜ 0.01] and severely damaged left ventricular diastolic function and higher carotid intima-media thickness [(0.7±0.3) vs (0.6±0.2) mm,P＜ 0.01].Nighttime blood pressure was independent predictor for proteinuria,eGFR and left ventricular mass index.Conclusions Nondipper blood pressure pattern is very common in CKD patients.Nighttime pressure is closely associated to renal damage and cardiovascular injuries.
