中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
11期
836-840
,共5页
孔羽%李航%余振球%杨赓
孔羽%李航%餘振毬%楊賡
공우%리항%여진구%양갱
难治性高血压%肾小球滤过率%动态动脉硬化指数
難治性高血壓%腎小毬濾過率%動態動脈硬化指數
난치성고혈압%신소구려과솔%동태동맥경화지수
Resistant hypertension%Glomerular filtration rate%Ambulatory arterial stiffness index
目的 探讨不同肾功能水平难治性高血压(RH)患者动态血压相关指数改变的临床意义.方法 回顾性分析2010年10月至2013年10月北京安贞医院高血压科住院患者401例的临床资料(其中RH患者263例,非RH患者138例),代入中国人修正“肾脏病膳食改良试验”(MDRD)公式评估肾功能(以GFR ＜60 ml·min-1·1.73 m-2为明显肾损害标准),进行24h动态血压监测得到各项血压参数;采用受试者工作特征曲线(ROC)判断各项动态血压指数改变在预测RH患者明显肾脏功能损害中的作用;采用多因素Logistic回归分析RH患者明显肾脏功能损害相关影响因素.结果 以GFR＜60 ml·min-1·1.73 m-2为切点构建RH患者动态血压参数ROC工作特征曲线提示动态动脉硬化指数(AASI)、24 h平均脉压(24 hPP)、收缩压夜间血压下降率(SBP夜间血压下降率)和24 h平均收缩压(24 hSBP)改变对RH肾功能损害有预测诊断作用,其各自截点值和ROC下面积分别为AASI≥0.485,0.804,P=0.000;24 hPP≥47.5 mmHg,0.644,P=0.006; SBP夜间血压下降率≤-1.75％,0.602,P=0.019;24 hSBP≥130.5 mmHg,0.623,P=0.008.多因素Logistic回归分析结果显示RH合并慢性肾脏病(CKD)相关危险因素有AASI(OR 1 268.5,P=0.000)、LDL水平(OR 0.7,P=0.01)和SBP夜间血压下降率(OR 1.3,P=0.01)是GFR ＜60 ml·min-1·1.73 m-2的独立危险因素.结论 动态血压相关参数改变对RH患者肾脏功能明显损害具有重要意义,其中AASI、24 hPP、SBP夜间血压下降率和24 hSBP的改变是预测RH患者明显肾功能损害的重要指标.
目的 探討不同腎功能水平難治性高血壓(RH)患者動態血壓相關指數改變的臨床意義.方法 迴顧性分析2010年10月至2013年10月北京安貞醫院高血壓科住院患者401例的臨床資料(其中RH患者263例,非RH患者138例),代入中國人脩正“腎髒病膳食改良試驗”(MDRD)公式評估腎功能(以GFR ＜60 ml·min-1·1.73 m-2為明顯腎損害標準),進行24h動態血壓鑑測得到各項血壓參數;採用受試者工作特徵麯線(ROC)判斷各項動態血壓指數改變在預測RH患者明顯腎髒功能損害中的作用;採用多因素Logistic迴歸分析RH患者明顯腎髒功能損害相關影響因素.結果 以GFR＜60 ml·min-1·1.73 m-2為切點構建RH患者動態血壓參數ROC工作特徵麯線提示動態動脈硬化指數(AASI)、24 h平均脈壓(24 hPP)、收縮壓夜間血壓下降率(SBP夜間血壓下降率)和24 h平均收縮壓(24 hSBP)改變對RH腎功能損害有預測診斷作用,其各自截點值和ROC下麵積分彆為AASI≥0.485,0.804,P=0.000;24 hPP≥47.5 mmHg,0.644,P=0.006; SBP夜間血壓下降率≤-1.75％,0.602,P=0.019;24 hSBP≥130.5 mmHg,0.623,P=0.008.多因素Logistic迴歸分析結果顯示RH閤併慢性腎髒病(CKD)相關危險因素有AASI(OR 1 268.5,P=0.000)、LDL水平(OR 0.7,P=0.01)和SBP夜間血壓下降率(OR 1.3,P=0.01)是GFR ＜60 ml·min-1·1.73 m-2的獨立危險因素.結論 動態血壓相關參數改變對RH患者腎髒功能明顯損害具有重要意義,其中AASI、24 hPP、SBP夜間血壓下降率和24 hSBP的改變是預測RH患者明顯腎功能損害的重要指標.
목적 탐토불동신공능수평난치성고혈압(RH)환자동태혈압상관지수개변적림상의의.방법 회고성분석2010년10월지2013년10월북경안정의원고혈압과주원환자401례적림상자료(기중RH환자263례,비RH환자138례),대입중국인수정“신장병선식개량시험”(MDRD)공식평고신공능(이GFR ＜60 ml·min-1·1.73 m-2위명현신손해표준),진행24h동태혈압감측득도각항혈압삼수;채용수시자공작특정곡선(ROC)판단각항동태혈압지수개변재예측RH환자명현신장공능손해중적작용;채용다인소Logistic회귀분석RH환자명현신장공능손해상관영향인소.결과 이GFR＜60 ml·min-1·1.73 m-2위절점구건RH환자동태혈압삼수ROC공작특정곡선제시동태동맥경화지수(AASI)、24 h평균맥압(24 hPP)、수축압야간혈압하강솔(SBP야간혈압하강솔)화24 h평균수축압(24 hSBP)개변대RH신공능손해유예측진단작용,기각자절점치화ROC하면적분별위AASI≥0.485,0.804,P=0.000;24 hPP≥47.5 mmHg,0.644,P=0.006; SBP야간혈압하강솔≤-1.75％,0.602,P=0.019;24 hSBP≥130.5 mmHg,0.623,P=0.008.다인소Logistic회귀분석결과현시RH합병만성신장병(CKD)상관위험인소유AASI(OR 1 268.5,P=0.000)、LDL수평(OR 0.7,P=0.01)화SBP야간혈압하강솔(OR 1.3,P=0.01)시GFR ＜60 ml·min-1·1.73 m-2적독립위험인소.결론 동태혈압상관삼수개변대RH환자신장공능명현손해구유중요의의,기중AASI、24 hPP、SBP야간혈압하강솔화24 hSBP적개변시예측RH환자명현신공능손해적중요지표.
Objective To explore the predictive values of ambulatory blood pressure-related parameters for moderate renal impairment in resistant hypertension (RH).Methods The clinical data were retrospectively analyzed for 401 hospitalized patients with hypertension at our hospital from October 2010 to October 2013.They were divided into RH (n =263) and non-RH (n =138).The modified estimating equation of glomerular filtration rate (GFR) for Chinese patients was used to assess renal functions.The standardization of moderate renal impairment was when GFR below 60 ml · min-1 · 1.73 m-2.The ambulatory blood pressure-related parameters were obtained by 24 h ambulatory blood pressure monitoring.The important prediction of these parameters for moderate renal impairment was accessed by receiver operating characteristic (ROC) curve.And the related risk factors for renal function impairment were tested by multiple stepwise Logistic regression analysis.Results Ambulatory arterial stiffness index (AASI),24 h mean pulse pressure (24 hPP),sleeptime relative systolic blood pressure (SBP) decline and 24 h systolic blood pressure (24 hSBP) had important predictive values for moderate renal impairment in RH.GFR was significantly lower in those with AASI ≥0.485,24 hPP ≥47.5 mmHg,sleeptime relative SBP decline ≤-1.75％ and 24 hSBP ≥ 130.5 mmHg (P ＜ 0.05).Area under curve of ROC curve of AASI,24 hPP,sleeptime relative SBP decline and 24 hSBP were 0.804,0.644,0.602 and 0.623 respectively.Multiple Logistic regression analysis showed that AASI (OR 1 268.5,P =0.000),low density lipoprotein (OR 0.7,P =0.01) and sleeptime relative SBP decline (OR 1.3,P =0.01) were independent risk factors for GFR ＜ 60 ml · min-1 · 1.73 m-2 in RH.Conclusion AASI,24 hPP,sleeptime relative SBP decline and 24 hSBP are the most significant ambulatory blood pressure-related parameters in predicting renal impairment in resistant hypertension.
