慢性肾脏病患者血压非勺型节律与左心室肥厚之间的关系

Association between non-dipping circadian blood pressure rhythm and left ventricular hypertrophy in chronic kidney disease patients

目的探讨24h动态血压（ABPM）非勺型节律与慢性肾脏病（CKD）患者左心室肥厚（LVH）之间的关系。方法共有257例CKD1～5期患者入选，根据肾功能分为两组：CKD1—3期组和CKD4～5期组。采用GE Marquette Tonoport V Eng动态血压计测定各组患者动态血压参数和昼夜节律；心脏彩色多普勒超声了解心脏结构的改变，并探讨血压非勺型节律与LVH之间的关系。结果CKD患者血压正常的生理节律丧失的现象普遍，总体血压非勺型昼夜节律发生率达75．4％，即使在血压正常者中也达到71．3％，随着肾功能下降血压非勺型昼夜节律的发生率也在上升。CKD患者血压非勺型节律组的心脏结构改变较勺型组明显，LVH的发生率也较高。相关性分析显示左室心肌质量指数（LVMI）与血压水平、非勺型的昼夜节律等相关。多元逐步回归分析显示24h-收缩压（SBP）（β=0．417，P〈0．01）、三酰甘油（β=-0．132，P=0．007）、血红蛋白（Hb）（β=-0．394，P=0．016）及性别（β=0．158，P=0．039）是影响LVMI的独立危险因素。结论CKD患者的血压非勺型昼夜节律现象普遍，并随着肾功能的下降其发生率逐渐升高。血压非勺型节律患者心脏结构改变更明显，LVH的发生率高。非勺型节律与LVMI密切相关。

Objective To clarify the association between non-dipping circadian blood pressure （BP） rhythm and left ventricular hypertrophy （LVH） in chronic kidney disease （CKD） patients. Methods A total of 257 CKD patients of stage 1 to 5 were enrolled in the study. The parameters of BP and circadian rhythm were measured by ambulatory BP monitoring （ABPM） and the cardiac structure was examined by eehoeardiography. The association between circadian BP rhythm and echocardiographic parameters was studied. Results The prevalence of abnormal circadian BP rhythm （non-dipping rhythm） was quite high （75.4%） in CKD patients and increased with the deterioration of renal function. Even if in the normal BP group, the prevalence of nondipping rhythm was 71.3%. The change of cardiac structure such as LVH in non-dipping patients was more obvious than the dipping patients. The left ventricular mass index （LVMI） was positively correlated with BP, non-dipping rhythm. Multiple regression analysis showed that 24 h-SBP （β= 0.417, P〈0.01）, triglyceride （TG） （β=-0.132, P=0.007）, Hb （β=-0.394, P=0.016） and gender（β= 0.158, P=0.039） were independent risk factors of LVMI. Conclusions The prevalence of nondipping rhythm is quite high in CKD patients and increases with the deterioration of renal function. The change of cardiac structure such as LVH is obvious in CKD patients, especially in non-dipping group. The non-dipping rhythm is related with LVMI.