脉压及夜间血压下降异常与2型糖尿病肾病的关系研究

The relationship between the ambulatory pulse pressure and impaired nocturnal blood pressure decline in progression of nephropathy in type 2 diabetic patients

目的评估脉压(pulse pressure,PP)及夜间血压下降异常(Impaired nocturnal BP decline)对2型糖尿病肾病的影响。方法对该院2004年1月-2008年12月收治的154例2型糖尿病患者作回顾性分析,根据尿白蛋白/血肌酐比值大小将糖尿病患者分为无肾病组37例(A组)和肾病组117例(B组),其中肾病组(B组)又分为早期肾病65例(B1组)和临床肾病52例(B2组)两个亚组,通过24h动态血压监测(ambulatory blood pressure monitoring,ABPM),收集相关数据进行分析。结果性别、年龄、糖尿病病程、BMI、HbA1C与2型糖尿病肾病的相关性不显著(P>0.05),而脉压及夜间血压下降异常与2型糖尿病肾病的进展呈显著相关(95%CI,1.248～3.262;1.468～3.682)。结论脉压及夜间血压下降异常是2型糖尿病患者肾病强有力的预测因素,临床上应及早进行干预,降低收缩压的同时防止舒张压过度降低,平稳降压,减小血压波动,对降低肾损害可起到积极作用。

Objective To evaluate the predictive value of ambulatory pulse pressure （PP） and decreased nocturnal BP reduction for Type 2 diabetic nephropathy progression.Methods A retrospective analysis of clinical features of diabetic nephropathy was conducted based on 154 cases in our department during the time from 2004 to 2008.There were 37 diabetes mellitus without nephropathy,117 diabetic nephmpathy which included 65 early diabetic nephmpathy and 52 diabetic nephmpathy with overt proteinuria. Serum levels of creadnine and blood pressure,albuminuria,HbA1C were monitored in the two groups,and their levels were compared.Results Age,sex,course of disease,BMI,HbA1C were not significantly different among the B groups.Pulse pressure and impaired nocturnal BP decline had significant positive effect on the progression of diabetic nephmpathy（95% CI：1.248-3.262 and 1.468-3.682）.Conclusions Ambulatory PP and impaired nocturnal BP decline are strong,independent predictors of nephropathy progression in type 2 diabetic patients.