中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2013年
2期
98-102
,共5页
尹道馨%张东亮%徐睿%冷雪飞%崔文英%刘文虎
尹道馨%張東亮%徐睿%冷雪飛%崔文英%劉文虎
윤도형%장동량%서예%랭설비%최문영%류문호
肾疾病%高血压%变异性,血压
腎疾病%高血壓%變異性,血壓
신질병%고혈압%변이성,혈압
Kidney diseases%Hypertension%Variability,blood pressure
目的 评价慢性肾脏病(CKD)3～4期高血压患者的诊间血压变异性对肾功能下降的影响.方法 152例研究对象来自首都医科大学附属北京友谊医院CKD专科门诊,每月测量患者血压,随访18个月,随访期间无降压药物的调整.计算每例研究对象随访期间的平均收缩压(SBP)、平均舒张压(DBP)及其标准差.依据SBP、DBP标准差中位数分为高SBP、高DBP标准差组和低SBP、低DBP标准差组,比较基线人口学特征及用药情况.采用多重线性回归分析SBP、DBP标准差对CKD 3～4期高血压患者肾功能下降的影响.结果 患者SBP、DBP标准差与肾功能下降显著相关；基线eGFR、基线尿微量白蛋白(LnACR)和随访平均SBP也对肾功能下降有影响(均P＜0.05).低SBP标准差组患者服用钙通道阻滞剂类降压药物比例显著高于高SBP标准差组(76.1％比58.2％,P＜0.05).结论 血压变异性与CKD3～4期患者肾功能下降显著相关,提示诊间血压变异性应受到更多关注,减少血压变异性的药物应作为降压治疗的首选.
目的 評價慢性腎髒病(CKD)3～4期高血壓患者的診間血壓變異性對腎功能下降的影響.方法 152例研究對象來自首都醫科大學附屬北京友誼醫院CKD專科門診,每月測量患者血壓,隨訪18箇月,隨訪期間無降壓藥物的調整.計算每例研究對象隨訪期間的平均收縮壓(SBP)、平均舒張壓(DBP)及其標準差.依據SBP、DBP標準差中位數分為高SBP、高DBP標準差組和低SBP、低DBP標準差組,比較基線人口學特徵及用藥情況.採用多重線性迴歸分析SBP、DBP標準差對CKD 3～4期高血壓患者腎功能下降的影響.結果 患者SBP、DBP標準差與腎功能下降顯著相關；基線eGFR、基線尿微量白蛋白(LnACR)和隨訪平均SBP也對腎功能下降有影響(均P＜0.05).低SBP標準差組患者服用鈣通道阻滯劑類降壓藥物比例顯著高于高SBP標準差組(76.1％比58.2％,P＜0.05).結論 血壓變異性與CKD3～4期患者腎功能下降顯著相關,提示診間血壓變異性應受到更多關註,減少血壓變異性的藥物應作為降壓治療的首選.
목적 평개만성신장병(CKD)3～4기고혈압환자적진간혈압변이성대신공능하강적영향.방법 152례연구대상래자수도의과대학부속북경우의의원CKD전과문진,매월측량환자혈압,수방18개월,수방기간무강압약물적조정.계산매례연구대상수방기간적평균수축압(SBP)、평균서장압(DBP)급기표준차.의거SBP、DBP표준차중위수분위고SBP、고DBP표준차조화저SBP、저DBP표준차조,비교기선인구학특정급용약정황.채용다중선성회귀분석SBP、DBP표준차대CKD 3～4기고혈압환자신공능하강적영향.결과 환자SBP、DBP표준차여신공능하강현저상관；기선eGFR、기선뇨미량백단백(LnACR)화수방평균SBP야대신공능하강유영향(균P＜0.05).저SBP표준차조환자복용개통도조체제류강압약물비례현저고우고SBP표준차조(76.1％비58.2％,P＜0.05).결론 혈압변이성여CKD3～4기환자신공능하강현저상관,제시진간혈압변이성응수도경다관주,감소혈압변이성적약물응작위강압치료적수선.
Objective To clarify the clinical significance of visit-to-visit variability in blood pressure (BP) of stage 3-4 chronic kidney disease (CKD) patients with hypertension.Methods One hundred and fifty-two cases of stage 3-4 CKD patients with hypertension were enrolled in the study.Variability in BP was defined as the standard deviation (SD) in BP.For each patient,SD and mean BP from BP measurements were calculated at all the visits.Correlations between the decline in estimated glomerular filtration rate (eGFR) and SD in BP were analyzed by multivariable regression.Results Visit-to-visit variability in BP was significantly associated with renal function decline (P ＜ 0.05),in addition,baseline eGFR,baseline albuminuria and mean SBP during follow-up were significantly associated with renal function decline as well (all P ＜ 0.05).The percentage of CCBs used in low SD of the SBP group was higher than that in high SD of the SBP (76.1％ vs 58.2％,P ＜ 0.05).Conclusion Visit-to-visit variability in BP is significantly associated with renal function decline.Drugs which can decrease the variability of blood pressure should be the first choice in the treatment of hypertension.
