老年原发性高血压患者早期肾功能损害的相关因素分析

Analysis of the relative factors of early renal impairment in elderly essential hypertension patients

目的观察老年原发性高血压患者的24h动态血压与尿中微量白蛋白（mAIb）的关系，探讨早期肾功能损害的相关因素。方法选择原发性高血压患者140例，测量24h动态血压各参数、高敏C反应蛋白（hs—CRP）、血脂及尿mAIb后，根据24h平均脉压分为A、B两组。A组68例，24h平均脉压40～60mmHg（1mmHg=0．133kPa）；B组72例，24h平均脉压≥60mmHg，对两组动态血压、hs—CRP、血脂、病程进行比较，并进行相关性分析。结果两组患者24h平均收缩压、昼间平均脉压、夜间平均脉压、尿mAIb、hsCRP、LDL-C比较有统计学差异（P〈0．05），且两组尿mAIb与24h平均收缩压、昼间平均脉压、夜间平均脉压、hs—CRP、LDLC呈显著正相关。经病程校正后，尿mAIb与24h平均收缩压、昼间平均脉压、夜间平均脉压、hs—CRP仍存在相关性（P〈0．05），与其他变量无相关性。结论24h平均收缩压、24h平均脉压可作为高血压患者早期肾损害的预测指标。

Objective To observe the relationship between average ambulatory blood pressure （ABPm）, dynamic pulse pressure, blood lipids, hs-CRP and urine microalbumin （mAIb） in elderly primary hypertension patients,in order to provide scientific evidence of use of ABPm for early di- agnosis and evaluation of hypertensive renal impairment. Methods 140 primary hypertension patients were studied. 24-hour SBP,24-hour DBP,24-hour average pulse pressure （day and night）, hs-CRP,blood lipids and urine mAIb were measured. The patients were divided into two groups based on the 24-hour mean pulse pressure：group A 40--60 mm Hg,group B ≥60 mm Hg. The parameters of blood pressure, hs-CRP, blood lipids and course of disease of the 2 groups were compared respectively and correlations of the data of the two groups were also analyzed. Results 24-hour SBP, average pulse pressure during daytime, average pulse pressure ,at night, urine mAIb, hs-CRP, LDL-C of the two groups were significantly different （P 〈 0.05）. The urine mAIb in each group had definitely positive correlation with 24-hour SBP, day pulse pressure （dPP）, night pulse pressure（nPP）, hs-CRP and LDC-C, but had no correlation with other parameters. After corrected for disease course,there was still positive correlation between the mAIb and 24-hour SBP,dPP,nPP and hs CRP,but other correlation disappeared. Conclusion The 24-hour SBP and 24-hour PP can be considered as predictive indexes of hypertensive renal impairment.