CAJ | 학술논문

目的探讨维持性血液透析(MHD)患者清晨高血压(MH)与心脑血管事件的关系。方法选取174例MHD伴高血压患者采用动态血压监测仪记录44h血压，根据清晨血压分为清晨高血压组(MH组,104例)和非清晨高血压组(NMH组,70例)，其中MH组分3型：持续型、非持续型、激增型。记录发生的心脑血管事件，随访2年，比较2组患者一般资料、心脑血管事件发生率及死亡率。结果与NMH组相比，MH组透析间期体质量增加值、睡眠障碍发生率、清晨收缩压、心脑血管事件发生率(67.3%比40%)和死亡率(13.5%比2.9%)明显升高(P＜0.05)，单室尿素清除指数(spKt/V)值显著低于 NMH 组(t=10.743,P＜0.01)；亚组中持续型患者心脑血管事件发生率(75.4%)高于激增型(66.7%)和非持续型(40%)(c2=8.815, P＜0.05)，3亚组间心脑血管事件死亡率无显著差异(c2=0.798,P＞0.05)；MH 组患者清晨收缩压值与心脑血管事件发生率呈正相关(r=0.700,P＜0.01)。结论 MHD伴高血压患者MH与心脑血管事件发生率密切相关，可能是心脑血管事件的独立危险因素。
목적탐토유지성혈액투석(MHD)환자청신고혈압(MH)여심뇌혈관사건적관계。방법선취174례MHD반고혈압환자채용동태혈압감측의기록44h혈압，근거청신혈압분위청신고혈압조(MH조,104례)화비청신고혈압조(NMH조,70례)，기중MH조분3형：지속형、비지속형、격증형。기록발생적심뇌혈관사건，수방2년，비교2조환자일반자료、심뇌혈관사건발생솔급사망솔。결과여NMH조상비，MH조투석간기체질량증가치、수면장애발생솔、청신수축압、심뇌혈관사건발생솔(67.3%비40%)화사망솔(13.5%비2.9%)명현승고(P＜0.05)，단실뇨소청제지수(spKt/V)치현저저우 NMH 조(t=10.743,P＜0.01)；아조중지속형환자심뇌혈관사건발생솔(75.4%)고우격증형(66.7%)화비지속형(40%)(c2=8.815, P＜0.05)，3아조간심뇌혈관사건사망솔무현저차이(c2=0.798,P＞0.05)；MH 조환자청신수축압치여심뇌혈관사건발생솔정정상관(r=0.700,P＜0.01)。결론 MHD반고혈압환자MH여심뇌혈관사건발생솔밀절상관，가능시심뇌혈관사건적독립위험인소。
Objective To investigate the correlation between morning hypertension (MH) and cardiovas-cular and cerebrovascular events in maintenance hemodialysis (MHD) patients. Methods Ambulatory blood pressure monitoring was done in 174 MHD patients with hypertension. They were classified as MH group (n=104) and non-MH group (n=70) based on the morning blood pressure. MH group was further classified into 3 types: sustained type, non-sustained type, and surge type. They were followed up for 2 years, and cardiovascu-lar and cerebrovascular events were recorded. General information, mortality and the incidence of cardiovas-cular and cerebrovascular events were compared between the two groups. Results Compared to non-MH group, weight gain in dialysis interval, the incidence of sleep disorders, morning systolic blood pressure (MSBP), the incidence of cardiovascular and cerebrovascular events (67.3% vs. 40%) and mortality (13.5%vs. 2.9%) were significantly increased (P<0.05) but spKt/V was significantly decreased (t =10.743, P<0.01) in MH group. The incidence of cardiovascular and cerebrovascular events was significantly higher in sus-tained type (75.4%) than in surge type (66.7%) and non-sustained type (40%) (c2=8.815, P<0.05), but the mortality was indifferent among the 3 types in MH group (c2=0.798, P>0.05). The value of MSBP was posi-tively correlated with the incidence of cardiovascular and cerebrovascular events in MH group (r=0.700, P<0.01). Conclusion MH closely correlates with the incidence of cardiovascular and cerebrovascular events in MHD patients with hypertension. MH may be an independent risk factor of cardiovascular and cerebrova-seuar events.