原发性高血压合并2型糖尿病患者血管紧张素Ⅱ、内皮素、血栓烷B2、动态血压监测参数与早期肾功能损害的关系

The relationship between Ang- Ⅱ ,ET, TXB2, ambulatory blood pressure and early renal impairment in hypertensive patients with type 2 diabetes mellitus

目的探讨原发性高血压（EH）合并2型糖尿病（T2DM）患者血管紧张素Ⅱ（AngⅡ）、内皮索（ET）、血栓烷B2（TXB2）、动态血压监测（ABPM）参数与早期肾功能损害的关系。方法将168例EH患者分为EH＋T2DM组（68例）和EH组（100例），对照组为体检正常者110例，对ABPM参数、血AngⅡ、ET、TXB2、β2微球蛋白（β2-MG）及尿β2-MG、白蛋白（ALB）、肌酐（Cr）等进行比较。结果（1）EH＋T2DM组、EH组ABPM参数、血AngⅡ、ET、TXB2、β2-MG及尿β2-MG、Alb、ALB／Cr与对照组比较，差异均有统计学意义（P〈0．01）。EH＋T2DM组与EH组比较，夜间平均收缩压（nMSBP）、24h平均收缩压（24hMSBP）、24h收缩压负荷值（24hSBPL）、夜间收缩压负荷值（nSBPL）、夜间脉压（nPP）差异均有统计学意义（P〈0．01或〈0．05）。（2）相关分析：血β2-MG及尿β2-MG、ALB、ALB／Cr与AngⅡ、ET、TXB3、ABPM参数均呈正相关，其中尿B2-MG、ALB与24hMSBP、白昼平均收缩压（dMSBP）、nMSBP、24hSBPL、白昼收缩压负荷值（dSBPL）、nSBPL相关性较好。结论EH合并T2DM患者有血管内皮功能障碍、血小板活性增强、收缩压增高，也有早期肾功能损害，它们之间呈正相关关系。治疗时既要控制血压、血糖，叉要改善血管内皮功能、调控血小板活性。

Objective To investigate the significance of Ang- Ⅱ ,ET, TXB2, ambulatory blood pressure monitoring （ABPM） to early renal impairment in hypertensive patients with type 2 diabetes mellitus （T2DM）. Methods One hundred and sixty-eight patients with essential hypertension （EH） were divided into EH plus T2DM group with 68 patients and EH group with 100 patients, with 110 normal healthy people being selected as control group. Comparison was made after measuring ABPM, blood Ang- Ⅱ ,ET, TXB2, β2-MG and urine β2-MG,ALB,Cr. Results （ 1 ） There was statistical difference in ABPM, blood Ang- Ⅱ, ET, TXB,, [32-MG and urine β2-MG, ALB, ALB/Cr among EH plus T2DM group, EH group and control group（P 〈 0.01 ）. There were statistical difference in nMSBP（P 〈 0.01 ）, 24hMSBP, 24hMSBPL, nSBPL and nPP （P〈 0.05 or 〈 0.01 ） between EH plus T2DM group and EH group, with remaining indicators having no statistical difference（P〉 0.05）. （2） Blood β2-MG,urine β2-MG,urine ALB,urine ALB/urine Cr were posilively correlated with Ang- Ⅱ ,ET, TXB2, ABPM, among which both urine β2-MG and urine ALB were strongly correlated with 24MSBP,dMSBP,nMSBP,24hMSBPL,dSBPL,nSBPL. Conclusions Both vascular endothelial dysfunction, enhanced platelet activity, elevated systolic blood pressure and early renal impairment, which are correlated with each other, could be found in patients with hypertension and diabetes. Treatment of patients with hypertension and diabetes requires both good control of blood pressure, blood glucose and improvement of vascular endothelial function, regulation of platelet activity.