早期慢性肾病患者动态血压变化与微量白蛋白尿的关系

The relationship between 24-h ambulatory blood pressure change and micrioalbuminuria in patients with early chronic kidney disease

目的分析早期慢性肾脏病（CKD）患者24h动态血压变化与尿微量白蛋白排泄率（UMAER）的关系。方法以25例正常人作为对照组（N组），71例肾功能稳定的CKD1期患者作为疾病组（D组）。收集24h动态血压监测（ABPM）资料及肾功能、尿微量白蛋白（UMA）、尿肌酐（UCr）等临床资料，计算UMAER及其对数，分析早期D组24h动态血压变化特点及其与微量白蛋白尿（MAU）的关系。结果与N组相比，D组夜问收缩压、昼、夜及24小时平均舒张压均升高（P均〈0．05）；夜间收缩压下降率及舒张压下降率均低下（P均〈0．05）。D组高血压及非杓型血压发生率分别达47．9％、62．0％。与杓刭血压组相比，非杓型血压组Ln（UMAER）值及MAU发生率均增高（P均〈0．01）。相关性分析显示UMAER与夜间收缩压呈正相关（P〈0．05）、与夜间收缩压下降率及夜间舒张压下降率均呈负相关（P均〈0．05）。结论早期CKD患者即已出现血压升高及血压节律改变；MAU产生与早期CKD患者夜间高血压及非杓型血压关系更密切。

Objective To study the relationship between 24-h ambulatory blood pressure change and the urinary micrioalbumin excretion rate in patients with early chronic kidney disease. Methods 25 normal persons were used as control group （N group） and 71 patients with CKD1 of stable renal function as disease group （D group）. 24-h ambulatory blood pressure monitoring （ABPM） data, renal function, urinary micrioalbumin （UMA）, urine creatinine （UCr） and other clinical data were collected; the urinary micrioalbumin excretion rate （UMAER） and its natural logarithm were calculated; and the relationship between ABPM data and microalbuminuria （MAU） in D group were analyzed. Results Nocturnal systolic blood pressure （nSBP）, day-, night- and 24-h average diastolic blood pressure were higher in D group than those in N group （P all 〈 0.05）. The decline rate of nocturnal systolic blood pressure （nDRS） and that of nocturnal diastolic blood pressure （nDRD） were lower （P both 〈 0.05）. The incidence of non-dipper blood pressure in D group was 47.9 %, and that of hypertension was 62.0%. Compared to the Dip group, non-Dip group had a higher natural logarithm of UMAER and a higher incidence of MAU （P both 〈0.05）. UMAER had a significant positive correlation with nSBP （P〈0.05）, and a significant negative correlation with nDRD and nDRS （P both 〈0.05）. Conclusion Hypertension and blood pressure rhythm change existed in patients with early CKD. MAU had a more close relationship with nocturnal hypertension and non-dipper blood pressure in patients with early CKD.