动态脉压对高龄高血压病患者早期肾功能损害的影响

Influence of ambulatory pulse pressure on early renal impairment in the very old patients with hypertension

目的探讨高龄高血压病患者动态脉压(APP)对早期肾功能损害的影响。方法应用24 h动态血压监测仪监测68例年龄≥80岁、常规尿蛋白(UP)、血清肌酐(SCr)、尿素氮(BUN)水平在正常范围的高血压病患者的APP水平,根据APP将患者分为两组,<60 mmHg为A组,≥60 mmHg为B组。测定两组患者UP、血清/尿肌酐(S/UCr)、BUN、尿微量白蛋白(UMA)、尿β2-微球蛋白(Uβ2-MG)水平。结果两组UP、SCr、BUN、Uβ2-MG差异均无显著性意义;B组UMA比A组明显增加〔(9.15±12.54)mg/mmol UCrvs(2.87±2.35)mg/mmol UCr〕,差异有显著性意义(P<0.01);UMA与APP呈显著性正相关(r=0.39,P<0.01)。结论APP高的高龄高血压病患者较APP低者的早期肾小球滤过功能损害更明显;APP越高,肾小球滤过功能损害越明显。

Objective To investigate the influence of ambulatory pulse pressure（APP） on early renal impairment in the very old patients（≥80 years old） with hypertension. Methods Sixty-eight very old patients were divided into two groups according to their APP （〈60 mmHg into A group, ≥60 mmHg into B group） measnred with ambulatory blood pressure monitor. The routine urine protein（UP）, serum/urine creatinine（S/UCr）, blood urea nitrogen （BUN）, urine microablumin（UMA） and urine [β2-microglobulin（U[β2-MG） of these patients were measured. Results There were no significant differences in UP,SCr,BUN and U[β2-MG between the two groups,UMA of B group was significantly increased as compared with that of A group[（9.15 ±12.54） mg/mmol UCr vs （2.87 ±2.35） mg/mmol UCr,P〈0. 01]. UMA positively correlated with APP（r=0.39,P〈0.01）. Conclusion Higher APP can induce more signiticant early renal impairment featured by impairment of glomerular filtration function in the very old patients with hypertension. The higher the APP,the worse the glomerular filtration function.