70岁以上老年心血管病患者肾功能与动态血压分析

Ambulatory blood pressure and renal function in patients aged 70 years or over with cardiovascular diseases

目的研究70岁以上老年心血管病患者肾功能与动态血压的关系。方法对因为心血管疾病住院的84例老年患者(70～87岁)以简化MDRD公式估算肾小球滤过率(GFR),以GFR<60ml/(min.1.73m2)定为慢性肾功能不全,与同期肾功能正常者比较24h动态血压各参数的变化。结果(1)肾功能不全组(44例)平均收缩压(SBP)>130mmHg者及冠心病、糖尿病、心力衰竭患病人数明显多于对照组;高血压及非"杓型"血压病例数两组比较差异无统计学意义。(2)肾功能不全组平均脉压(PP)明显高于对照组,最高舒张压(DBPmax)、舒张压波动幅度(ΔDBP)明显低于对照组。(3)患者年龄与SBP、PP、夜间SBP(nSBP)及夜间SBP负荷正相关;血清肌酐(SCr)与PP、最低SBP、nSBP正相关,与DBPmax、ΔDBP负相关,GFR呈对应改变;在控制年龄因素后,SCr与PP、nSBP相关性依然显著。结论老年心血管病患者PP增大、nSBP增高和DBPmax、ΔDBP降低与肾功能损害有关,肾功能不全患者中更多的患有冠心病、糖尿病、心力衰竭,并存在更为明显的动态血压变化。

Objective To investigate the relationship between ambulatory blood pressure （ABP） and renal dysfunction in patients aged ≥70 years with cardiovascular diseases（CVD）. Methods Eighty-four patients aged 70-87 years with CVD were included. The glomerular filtration rate （GFR） was estimated with the simplified Modification of Diet in Renal Disease study （MDRD） equation,and GER 60 ml/（min·1.73 m2） was considered as renal dysfunction. The patients were divided into renal dysfunction group （n=44） and control group with normal renal function （n=40）. The 24-hour ABP parameters were compared between two groups. Results There were more patients with coronary artery disease,diabetes,heart failure or mean systolic blood pressure（SBP） 130 mmHg in renal dysfunction group than in control group. There was no significant difference in numbers of hypertension cases and non-dipper blood pressure cases. The mean pulse pressure （PP） was significantly higher,while maximal diastolic blood pressure （DBPmax） and wave amplitude of DBP （ΔDBP） were lower in renal dysfunction group than in control group. Mean SBP,PP,nocturnal SBP （nSBP） and nSBP load were positively correlated with the patients age. Serum creatinine（SCr） was positively correlated with PP,nSBP and minimum SBP （SBPmin）,and negatively correlated with DBPmax and ΔDBP. GFR changed correspondingly. The correlation of SCr with PP and nSBP remained significant after age-matching. Conclusion The increase in PP and nSBP and the decline in DBPmax and ΔDBP are correlated with renal dysfunction in aged patients with CVD. Patients with renal dysfunction are more vulnerable to suffer from coronary artery disease,diabetes,and heart failure. They also displayed more remarkable changes of ABP.