维持性血液透析患者24h动态血压与心脏结构功能相关性研究

Investigation of the correlation of the parameters of 24-hour ambulatory blood pressure monitoring and cardiac function in maintenance hemodialysis patients

目的探讨维持性血液透析患者24h动态血压与心脏结构功能的关系。方法研究对象为上海交通大学医学院附属仁济医院肾脏科维持性血液透析患者和慢性肾脏病(CKD)5期非透析患者各31例。采用动态血压计测定各组患者动态血压(ABPM),收集24h平均收缩压(24h-SBP),24h平均舒张压(24h-DBP),24h平均动脉压(24h-MAP),白昼平均收缩压(D-SBP),白昼平均舒张压(D-DBP),夜间平均收缩压(N-SBP)和夜间平均舒张压(N-DBP)以及昼夜节律。用超声心动图测定左心室舒张末内径(LVDd)、左心室收缩末内径(LVDs)、左房内径(LAD)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)。并收集临床指标。结果比较两组患者左心室肥大(LVH)发生比率,LVDd、LVDs和LVMI值,血液透析组要高于非透析组,而射血分数较低。血液透析组的24h-SBP,24h-DBP,24h-MAP,D-SBP,D-DBP,N-SBP和N-DBP均显著性高于非透析组;并且其非勺型血压比率也显著性增高(90.3%vs64.5%,P=0.015)。在24h平均白昼、夜间高血压比率及夜间收缩期高血压比率方面,血液透析组也明显高于非透析组。血液透析组24h平均血压<135/85mmHg的患者中夜间非勺型血压的比率也高达87.5%。血液透析组患者的心脏结构的改变与患者的血压密切相关,尤其与收缩压及夜间非勺型血压呈正相关;另外还与Alb、PTH、透析龄和透析剂量存在相关。结论维持性血液透析患者普遍存在高血压或血压节律改变,夜间非勺型节律以及夜间收缩压升高与这些患者心脏结构和功能改变关系密切。

Objective To analyze the relationship between the parameters of 24-hour ambulatory blood pressure monitoring （ABPM） and cardiac function in maintenance hemodialysis （MHD） patients. Methods Thirty-one MHD patients and 31 pre-ESRB patients were enrolled. 24- hour average systolic （24h-SBP）, 24-hour average diastolic （24h- DBP）, 24-hour average mean arterial （24h-MAP）, Daytime average systolic （D-SBP）, Daytime average diastolic （D-DBP）, Night-time average systolic（N-SBP）, Nighttime average diastolic（N-DBP） blood pressure and circadian blood pressure rhythm were measured by ABPM. The left ventricular end-diastolic diameter （LVDd）, left ventricular end-systolic diameter（LVDs）, left atrial diameter（LAD）, left ventricular posterior wall thickness（LVPWT）, interventricular septal thickness（IVST） were detected by ultrasonic cardiography. And other correlated parameters were also measured. Results The left ventricular hypertrophy（LVH）, LVDd, LVDs and LVMI increased in MIlD patients compared with pre- ESRD patients, while the fractional shortening decreased significantly. The levels of 24h-SBP, 24h-DBP, 24h-MAP, D-SBP, D-DBP, N-SBP and N-DBP increased significantly in MND patients compared with the pre-ESRD patients, especially the non-dipper hypertension（90. 3% vs 64. 5%, ＇P= 0. 015）.The percentage of hypertension at 24-hour average, Daytime average, Nighttime average blood pressure and N-SBP were higher in MIlD patients compared with the control group. The non-dipper blood pressure in MIlD patients whose 24-hour average blood pressure lower than 135/85mm Hg were 87.5%. The blood pressure was found positively correlated with cardiac function, especially the SBP and non-dipper blood pressure rhythm. On the other hand, Alb, iPTH, duration of hemodialysis were also correlated with cardiac function. Conclusion The incidence of hypertension and non-dipper hypertension is very high in MIlD patients. The cardiac function in maintenance hemodialysis is closely correlated with non-dipper blood pressure rhythm and high N-SBP.