高尿酸血症与老年高血压患者肾功能和动态血压变化

Relationship of hyperuricaemia with ambulatory blood pressure and renal function in elderly patients with hypertension

目的探讨高尿酸血症对老年高血压患者肾功能和动态血压的影响。方法对已服用降压药物控制血压的老年(61～87岁)高血压患者测定血清尿酸(SUA)、肌酐(SCr)和24h动态血压,以简化MDRD公式估算的肾小球滤过率(GFR)<60 ml.min-1.1.73 m-2的45例为肾功能不全组,与同期年龄性别匹配的45例GFR≥60 ml.min-1.1.73 m-2患者对照,比较高尿酸血症对患者肾功能和动态血压参数的影响。结果 (1)患者SUA水平与GFR呈负相关,r=-0.377,P<0.01。肾功能不全组SUA明显高于对照组[(413.7±97.5)μmol/L vs(340.8±90.6)μmol/L,P<0.01]。(2)检出高尿酸血症36例(40%),肾功能不全组高尿酸血症患者明显多于对照组(26/45 vs 10/45,χ2=11.852,P<0.01)。(3)患者SUA水平与舒张压(DBP)、夜间DBP(nDBP)呈负相关,r=-0.255、-0.233,均P<0.05;与脉压(PP)、日间PP(dPP)、nPP以及日间SBP负荷呈正相关,分别为r=0.228、0.217、0.220、0.210,均P<0.05;其中DBP、脉压(PP)、nPP为肾功能不全组显著异于对照组的血压参数。结论并有肾功能不全的老年高血压患者血清尿酸明显增高,对患者的血压变化和肾功能存在不利影响。降压治疗中注意血清尿酸的变化可能有益于患者的降压疗效和肾功能保护。

Objective To investigate the effect of high serum uric acid（SUA） level on ambulatory blood pressure and renal function in elderly patients.with hypertension.Methods The data of a matched case-control study in 90 elderly patients（age： 61-87 years） with hypertension were analyzed.The detection of serum uric acid（SUA）,serum creatinine（SCr）,and ambulatory blood pressure monitoring（AMBP） were performed.The glomerular filtration rate（GRF） was estimated with the simplified modification of diet in renal disease study（MDRD） equation.The 45 patients with GFR less than 60 ml/min per 1.73m^2 were definited to renal dysfunction.Results The GFR was negatively correlated with SUA level in all the patients.The significantly increased SUA level and more hyperuricaemia cases were found in the group with renal dysfunction in contrast with the control,（413.7±97.5） μmol/L vs（340.8±90.6） μmol/L.The rate of patients with high SUA were 36（40%）.The levels of SUA were negatively correlated with mean diastolic blood pressure（DBP） and nocturnal DBP（nDBP）（r=-0.255 and-0.233） and positively correlated with pulse pressure（PP）,daytime PP（dPP） and nocturnal PP（nPP）（r=0.228,0.217 and 0.220,P〈0.05）.Among them,the DBP was significantly lower,but the pulse pressure（PP） and（nPP） were significantly higher in renal dysfunction group compared with the control（P〈0.05）.Conclusion The level of SUA remarkably increased in elderly hypertension patients with renal dysfunction.The increased level of SUA had adverse effects on blood pressure and renal function of these patients.It is shown that decreasing SUA level in the therapy of hypertension should benefit to renal function and blood pressure control.