不同阶段慢性肾脏病患者24小时血压动态变化特点

Features of 24-hour ambulatory blood pressure in different stages of chronic kidney disease patients

目的:研究不同阶段慢性肾脏病(CKD)患者24小时(24 h)血压动态变化情况。方法:纳入2016年9月至2018年9月期间华中科技大学协和江南医院收治的416例CKD患者作为研究对象,按肾小球滤过率标准将CKD患者分为5期,每期为一组,分别为CKD1期(CKD1组,n=132)、CKD2期(CKD2组,n=108)、CKD3期(CKD3组,n=89)、CKD4期(CKD4组,n=54)以及CKD5期(CKD5组,n=33)。对所有患者均进行24 h动态血压检测,分析不同阶段CKD患者24 h动态血压变化特点及心功能指标变化情况,观察不同阶段CKD患者动态血压模型情况。结果:CKD5组患者24 h心率与日间心率水平与CKD1组患者无差异(P>0.05),其余指标包括24 h-SBP、24 h-DBP、d-SBP、d-DBP、n-SBP、n-DBP、24 h脉压、日间脉压、夜间脉压以及夜间心率水平均明显高于CKD1~CKD4组患者;24 h心率与日间心率水平均明显高于CKD2~CKD4组患者(均P<0.05)。CKD4组患者24 h-SBP、24 h-DBP、d-SBP、d-DBP、n-SBP以及n-DBP水平均高于CKD1~CKD3组患者;CKD3~CKD4组患者24 h脉压、日间脉压以及夜间脉压水平均高于CKD1~CKD2期患者(均P<0.05)。CKD1~CKD5组患者E/A水平对比无差异(P>0.05)。CKD5组患者LVDd、IVST、LVPWT以及LVMI水平均大于CKD1~CKD4组患者;CKD4组患者IVST、LVPWT以及LVMI水平均大于CKD1~CKD3组患者(P<0.05)。CKD1~CKD5组患者动态血压模型包括深勺型、勺型、非勺型以及反勺型。CKD1~CKD5组患者动态血压模型均以非勺型为主,明显高于其他动态血压模型所占比例(均P<0.05)。CKD1~CKD5组患者动态血压模型动态血压不同模型所占比例各组间并无差异(P>0.05)。结论:CKD患者主要以非勺型血压模式为主,随着CKD疾病进展,患者血压大体呈升高趋势,心功能呈下降趋势。心肌结构和功能的改变可能是由于CKD患者血压改变所致。

Objective:To study the changes of 24-hour ambulatory blood pressure in different stages of chronic kidney disease(CKD)patients.Methods:A total of 416 CKD patients treated from Septem-ber 2016 to September 2018 in our hospital were selected.According to glomerular filtration rate,pa-tients were assigned to CKD1 group(n=132),CKD2 group(n=108),CKD3 group(n=89),CKD4 group(n=54),and CKD5 group(n=33).24-hour ambulatory blood pressure was recorded and cardi-ac function changes were analyzed.24-hour ambulatory blood pressure archetype models in different stages of CKD patients were analyzed.Results:No significant difference was shown in 24-hour heart rate and daytime hear rate between CKD5 group and CKD1 group(P>0.05);other indicators like24-hour systolic blood pressure(24 h-SBP),24-hour diastolic blood pressure(24 h-DBP),d-SBP(daytime systolic blood pressure),d-DBP(daytime diastolic blood pressure),n-SBP(nighttime systol-ic blood pressure),n-DBP(nighttime diastolic blood pressure),24-hour pulse pressure,daytime and nighttime pulse pressure and nighttime heart rate in CKD5 group were significantly higher than those of CKD1-4 groups;24-hour heart rate and daytime heart rate were higher than those of CKD2-4 groups(P<0.05);24 h-SBP,24 h-DBP,d-SBP,d-DBP,n-SBP and n-DBP values in CKD4 group were higher than those of CKD 1-3 groups;24 h pulse pressure,daytime and nighttime pulse pressure in CKD3-4 groups were higher than those of CKD1 and CKD2 groups(P<0.05);no significant differ-ence was shown in E/A(early diastolic peak flow/late diastolic peak flow velocity)ratio among CKD1-5 groups(P>0.05);LVDd(left ventricular end-diastolic diameter),IVST(inter-ventricular septal thickness),LVPWT(left ventricular posterior wall thickness),and LVMI(left ventricular weight in-dex)values in CKD5 group were larger than those of CKD1-4 groups;IVST,LVPWT and LVMI in CKD4 group were larger than those of CKD 1-3 groups(P<0.05);the ambulatory blood pressure ar-chetype models for CKD1-5 groups included deep scoop type,scoop type,non-scoop type,and in-verted scoop type.The ratio of non-scoop type for CKD1-5 groups was significantly higher than that of other models(P<0.05);the ratio of different archetype models among CKD 1-5 groups showed no difference(P>0.05).Conclusion:CKD patients generally are non-scoop type.With the progression of CKD,blood pressure principally shows an increasing trend while cardiac function shows a declining trend.The changes of myocardial structure and function may bring about the blood pressure changes in CKD patients.