中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
25期
3054-3058
,共5页
刘静%王丽妍%尹道馨%冷雪飞%刘文虎
劉靜%王麗妍%尹道馨%冷雪飛%劉文虎
류정%왕려연%윤도형%랭설비%류문호
慢性肾脏病%高血压%肾功能
慢性腎髒病%高血壓%腎功能
만성신장병%고혈압%신공능
Chronic kidney disease%Hypertension%Renal function
目的：探讨血压控制水平对慢性肾脏病（ CKD）患者肾功能的影响。方法建立 CKD 患者队列，纳入患者均为2011年1月—2012年12月在首都医科大学附属北京友谊医院肾内科门诊就诊的 CKD 患者，患者入组后，每月随访1次。最终，可将诊室血压控制在≤140/90 mm Hg 水平（70％及以上时间）的患者共有148例，根据具体血压控制情况，将该148例患者分为3组：A 组（n ＝96），收缩压＜120 mm Hg，舒张压＜70 mm Hg；B 组（n ＝28），120 mm Hg≤收缩压≤130 mm Hg，70 mm Hg≤舒张压≤80 mm Hg；C 组（n ＝24），131 mm Hg≤收缩压≤140 mm Hg，81 mm Hg≤舒张压≤90 mm Hg。记录并比较3组基线资料和实验室检测指标，每月随访时记录患者用药情况，探讨血压控制水平对 CKD 患者肾功能的影响。结果3组平均年龄和肾脏原发病比较，差异有统计学意义（P ＜0.05）；而性别、BMI、吸烟情况比较，差异无统计学意义（P ＞0.05）。3组基线尿清蛋白/肌酐比值（ACR）和基线估算肾小球滤过率（eGFR）比较，差异有统计学意义（P ＜0.05）。3组基线、末次随访时的限定日剂量（DDD）比较，差异有统计学意义（P ＜0.05）；3组 DDD 调整量比较，差异亦有统计学意义（P ＜0.05）；末次随访时，B、C 组 DDD 与基线比较，差异有统计学意义（ P ＜0.05）；B、C 组 DDD 调整量与 A 组比较，差异有统计学意义（ P ＜0.05）。多因素Logistic 回归分析显示，肾脏原发病、基线 ACR、基线 eGFR 对 CKD 患者 eGFR 的影响有统计学意义（P ＜0.05）；而性别、年龄、血压对其影响无统计学意义（P ＞0.05）。结论在一定范围内，血压不是 CKD 患者肾功能的影响因素；而肾脏原发病、基线 ACR、基线 eGFR 是其影响因素。对于临床上无法将血压控制在120/70 mm Hg 以下的患者，可将其血压水平控制在131～140/81～90 mm Hg 以内。
目的：探討血壓控製水平對慢性腎髒病（ CKD）患者腎功能的影響。方法建立 CKD 患者隊列，納入患者均為2011年1月—2012年12月在首都醫科大學附屬北京友誼醫院腎內科門診就診的 CKD 患者，患者入組後，每月隨訪1次。最終，可將診室血壓控製在≤140/90 mm Hg 水平（70％及以上時間）的患者共有148例，根據具體血壓控製情況，將該148例患者分為3組：A 組（n ＝96），收縮壓＜120 mm Hg，舒張壓＜70 mm Hg；B 組（n ＝28），120 mm Hg≤收縮壓≤130 mm Hg，70 mm Hg≤舒張壓≤80 mm Hg；C 組（n ＝24），131 mm Hg≤收縮壓≤140 mm Hg，81 mm Hg≤舒張壓≤90 mm Hg。記錄併比較3組基線資料和實驗室檢測指標，每月隨訪時記錄患者用藥情況，探討血壓控製水平對 CKD 患者腎功能的影響。結果3組平均年齡和腎髒原髮病比較，差異有統計學意義（P ＜0.05）；而性彆、BMI、吸煙情況比較，差異無統計學意義（P ＞0.05）。3組基線尿清蛋白/肌酐比值（ACR）和基線估算腎小毬濾過率（eGFR）比較，差異有統計學意義（P ＜0.05）。3組基線、末次隨訪時的限定日劑量（DDD）比較，差異有統計學意義（P ＜0.05）；3組 DDD 調整量比較，差異亦有統計學意義（P ＜0.05）；末次隨訪時，B、C 組 DDD 與基線比較，差異有統計學意義（ P ＜0.05）；B、C 組 DDD 調整量與 A 組比較，差異有統計學意義（ P ＜0.05）。多因素Logistic 迴歸分析顯示，腎髒原髮病、基線 ACR、基線 eGFR 對 CKD 患者 eGFR 的影響有統計學意義（P ＜0.05）；而性彆、年齡、血壓對其影響無統計學意義（P ＞0.05）。結論在一定範圍內，血壓不是 CKD 患者腎功能的影響因素；而腎髒原髮病、基線 ACR、基線 eGFR 是其影響因素。對于臨床上無法將血壓控製在120/70 mm Hg 以下的患者，可將其血壓水平控製在131～140/81～90 mm Hg 以內。
목적：탐토혈압공제수평대만성신장병（ CKD）환자신공능적영향。방법건립 CKD 환자대렬，납입환자균위2011년1월—2012년12월재수도의과대학부속북경우의의원신내과문진취진적 CKD 환자，환자입조후，매월수방1차。최종，가장진실혈압공제재≤140/90 mm Hg 수평（70％급이상시간）적환자공유148례，근거구체혈압공제정황，장해148례환자분위3조：A 조（n ＝96），수축압＜120 mm Hg，서장압＜70 mm Hg；B 조（n ＝28），120 mm Hg≤수축압≤130 mm Hg，70 mm Hg≤서장압≤80 mm Hg；C 조（n ＝24），131 mm Hg≤수축압≤140 mm Hg，81 mm Hg≤서장압≤90 mm Hg。기록병비교3조기선자료화실험실검측지표，매월수방시기록환자용약정황，탐토혈압공제수평대 CKD 환자신공능적영향。결과3조평균년령화신장원발병비교，차이유통계학의의（P ＜0.05）；이성별、BMI、흡연정황비교，차이무통계학의의（P ＞0.05）。3조기선뇨청단백/기항비치（ACR）화기선고산신소구려과솔（eGFR）비교，차이유통계학의의（P ＜0.05）。3조기선、말차수방시적한정일제량（DDD）비교，차이유통계학의의（P ＜0.05）；3조 DDD 조정량비교，차이역유통계학의의（P ＜0.05）；말차수방시，B、C 조 DDD 여기선비교，차이유통계학의의（ P ＜0.05）；B、C 조 DDD 조정량여 A 조비교，차이유통계학의의（ P ＜0.05）。다인소Logistic 회귀분석현시，신장원발병、기선 ACR、기선 eGFR 대 CKD 환자 eGFR 적영향유통계학의의（P ＜0.05）；이성별、년령、혈압대기영향무통계학의의（P ＞0.05）。결론재일정범위내，혈압불시 CKD 환자신공능적영향인소；이신장원발병、기선 ACR、기선 eGFR 시기영향인소。대우림상상무법장혈압공제재120/70 mm Hg 이하적환자，가장기혈압수평공제재131～140/81～90 mm Hg 이내。
Objective To explore the influence of different levels of blood pressure control on the renal function of patients with chronic kidney disease(CKD). Methods A cohort of CKD patients was established. The enrolled patients were all CKD patients who received treatment in the Nephrology Department of Beijing Friendship Hospital Affiliated to Capital Medical University from January 2011 to December 2012. Monthly follow - up visits were conducted for each patient. At last,there were a total of 148 patients whose blood pressure was controlled within the following levels(for 70% or above of follow - up period). According to the blood pressure control level,the 148 patients were divided into three groups:group A( n = 96,SBP < 120 mm Hg,DBP < 70 mm Hg),group B(n = 28,120 mm Hg≤SBP≤130 mm Hg,70 mm Hg≤DBP≤80 mm Hg)and group C (n = 24,131 mm Hg≤SBP≤140 mm Hg,81 mm Hg≤DBP≤90 mm Hg). The baseline data and laboratory indexes were recorded and compared,and the medication status of patients was recorded in follow - up visits. The influence of different levels of blood pressure control on the kidney function of CKD patients was investigated. Results The three groups were significantly different in average age and kidney protopathies(P < 0. 05);the three groups were not significantly different in gender,BMI and smoking condition(P > 0. 05). The three groups were significantly different in ACR and eGFR( P < 0. 05). The three groups were significantly different in baseline DDD and DDD in final follow - up visit( P < 0. 05);the three groups were significantly different in the adjustment amount of DDD(P < 0. 05);in the final follow - up visit,DDD of group B and DDD of group C were significantly different from baseline(P < 0. 05),and the adjusted amounts of DDD of group B and group C were significantly different from group A(P < 0. 05). The multivariate logistic regression analysis showed that kidney protopathies, baseline ACR,baseline eGFR had significant influence on eGFR of CKD patients(P < 0. 05),while gender,age and blood pressure had no significant influence(P > 0. 05). Conclusion Within a certain range,blood pressure is not an influencing factor for the kidney function of CKD patients;while kidney protopathy,baseline ACT and baseline eGFR are influencing factors. For patients whose blood pressure can not be controlled under 120 / 70 mm Hg,their blood pressure could be controlled within 131 ~ 140 / 81 ~ 90 mm Hg.
