IgA肾病患者血压节律及其与临床病理指标的关系

Blood pressure rhythm and its association with clinicopathological indices in patients with IgA nephropathy

目的探讨IgA肾病患者血压昼夜节律与临床病理指标的关系。方法采用横断面调查研究。选择2009年3月至8月在IgA肾病数据库登记的原发性IgA肾病患者，收集临床病理资料，并通过动态血压监测IgA肾病患者血压昼夜节律情况。用（日间血压平均值一夜间血压平均值）／日间血压平均值判断血压昼夜节律状况。比较血压节律正常组及异常组的临床病理指标。结果共93例患者完成动态血压监测并纳入分析，其中68例（73％）血压节律消失，在慢性肾脏病（CKD）1期、2期及3期以上组血压节律消失的比例分别70％、70％及81％，3组间差异无统计学意义（P=0．587）。非勺型血压在血压正常组与高血压组比例分别为69％和77％（P=O．373）。血压节律消失与年龄、性别、血压、蛋白尿、肾功能以及肾脏病理损伤程度无相关。在随访时间超过12个月的54例中，非勺型血压组eGFR下降速率虽快于勺型血压组，但差异无统计学意义（P=0．329）；在其中29例并发高血压患者中，非勺型血压组eGFR下降速率快于勺型血压组，且差异有统计学意义[（-6．79±11．58）比（-0．34±1．74）ml·min-1·（1．73m2）-1·年-1，P=0．0191。结论IgA肾病早期即可出现明显的血压节律消失。IgA肾病伴高血压患者的血压节律消失可能是影响肾功能进展的危险因素。

Objective To investigate the blood pressure circadian rhythm in patients with IgA nephropathy by ambulatory blood pressure monitoring and explore its role in the disease progression. Methods A cross sectional study was carried out. Blood pressure rhythm was studied by ambulatory 24-hour monitoring with a portable oscillometric recorder in selected patients with primal＂y IgA nephropathy. The term ＂dipper＂ was described as blood pressure during night dropped at least 10% below daytime blood pressure. The term ＂non-dipper＂ referred to those in whom the nocturnal decline in blood pressure was less than 10%. Clinieopathological indices between clipper and non-dipper groups were compared. Results Ninety-three patients completed ambulatory blood pressure monitoring among whom 68 （73%） patients were non-dipper. The frequency of non-dipper was 70%, 70% and 81% in the patients at chronic kidney disease stage 1,2 and 3 or more. The frequency did not differ among these three group patients （P=0.587）. 77% of patients with hypertension and 69% of patients with normotension were non-dipper （P=0.373）. The disappearance of blood pressure circadian rhythm in IgA nephropathy was not influenced by age, gender, blood pressure, proteinuria, renal function and renal pathology lesions. Among the patients who were followed up regularly for more than 12 months （n=54）, patients in the dipper group had a trend of slower eGFR decline rate than those in non-dipper group albeit the difference was not significant （P=0.329）. Subgroup analysis revealed that in patients with hypertension and non-dipper （n=29）, the eGFR decline rate was much faster than that in dipper group[（-6.79±11.58）vs （-0.34±1.74） ml-min-1 （1.73 m2）-1 year-1, P=0.019]. Conclusions Most patients with IgA nephropathy present disappearance of blood pressure circadian rhythm, even among those at an early stage or without hypertension. The loss of blood pressure rhythm may be associated with a rapid renal function decline rate in those with hypertension.