糖尿病肾病动态血压的特点及相关性研究

The study on the characteristics and corralationship of ambulatory blood pressure in type 2 diabetic nephropathy patients

目的 :探讨正常血压 2型糖尿病肾病 (DN) (Ⅲ期 )动态血压 (ABP)的特点及其影响因素。 方法 :用 2 4h动态血压监测仪监测 2 2例偶测血压正常的DN(Ⅲ期 )病人 2 4h动态血压 (ABP) ,同时测定尿白蛋白排泄率 (RU AE)、血糖、血脂、体重指数、眼底改变 ,分析其相关性。以动态血压为因变量做多元相关分析。 结果 :2 2例偶测血压正常的DN病人中 2 0例高血压 ,每例病人夜间收缩压、舒张压下降百分率均明显降低 ,昼夜节律消失。DN病人 2 4h平均收缩压和平均舒张压均与年龄呈正相关 (P <0 .0 5 ) ;RUAE与 2 4h平均舒张压 (MDP)夜间舒张压下降百分率 (ΔDBP)呈正相关 (P <0 .0 5 )。 结论 :早期DN病人偶测血压正常者已存在 2 4h动态血压节律性异常 ,这种昼夜血压节律性异常与病人的年龄、尿白蛋白排泄率相关。对糖尿病患者进行动态血压监测较偶测血压更易发现夜间血压异常。

Objective: The characteristics of ambulatory blood pressure and the relationship between the former and its various influencial factors were investigated in normotensive type 2 diabetic nephropathy patients(the third stage). Methods: The associations of ambulatory blood pressure and circadian rhythm of blood pressure (by using an ambulatory equipment) with AER (by RIA)、 plasma glucose (by glucose oxidase method)、 HbAic(by chromatography)、 serum TCh, Tg, HDL-c (by biochemical autoanalyzer) and the clinical features were evaluated in 22 cases of type 2 diabetic nephropathy patients without hypertension. The canonical analysis was used with the ambulatory blood pressure as the dependent variable. Results: (1) 20 out all of the cases are of hypertension. The percentage of reduction during night time SBP and DBP were significantly decreased and the circadian rhythm of blood pressure is dispeared in all patients. (2) The age of the patients has a positive effect on the 24h mean blood pressure (P<0.01, P<0.05). There was a better correlation between the average 24 h DBP, the percentage of reduction in the night time DBP and the urine albumin excretion (P<0.05). Conclusions: The evaluated UAER, the age of the patients were the main aspects to affect ambulatory blood pressure. The results suggest that DN patients are likely to lose their normal diurnal BP rhythm even at the time when they are still normotensive. Therefore, patients with DN should have ABP monitoring periodically for it is more easily to detect abnormal changes in ABP profiles.