540例慢性肾脏病患者动态血压的特点

Features of ambulatory blood pressure in 540 patients with chronic kidney disease

目的探讨慢性肾脏病患者动态血压的特点、影响因素及与靶器官损害的关系。方法以2010年5月至2012年5月中山大学附属第三医院肾内科慢性肾脏病患者540例为研究对象。以携带式动态血压计进行动态血压监测，同时测量尿蛋白等临床指标。用心脏超声评价心脏结构和功能改变；高频超声评价颈部血管中膜厚度及斑块情况。用单因素和多因素分析探讨动态血压监测结果与临床指标的关系。结果63．9％患者血压模式为非勺型，36．1％患者为勺型。与勺型血压患者相比，非勺型血压患者的夜间／白天尿蛋白比例较高（0．51±0．29比0．42±0．21，P〈0．01），肾小球滤过率较低[（56．2±48．2）比（75．5±56．5）ml·min-1·（1．73m2）-1，P〈0．01]，血清胱抑素C较高[（2．8±2．0）比（2．1±2．0）mg/L，P〈0．01]，颈部血管内中膜厚度较大[（0．7±03）比（0．6±0．2）mm，P〈0．01]，左室质量指数较高[（53．7±23．2）比（45．1±16．3）g/m2，P〈0．01]，舒张功能低下。夜间血压是慢性肾脏病患者的蛋白尿、。肾小球滤过率、左室质量指数的独立预测指标。结论非勺型血压模式是慢性肾脏病患者最常见的血压模式。夜间血压与患者的靶器官损伤密切相关。

Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease （CKD） patients. Methods A total of 540 CKD patients from May 2010 to May 2012 in our department were enrolled in this study. Ambulatory blood pressure monitoring was carried out. Blood pressure （BP）, proteinuria and other clinical parameters were measured regularly. Ultrasonography was used to evaluate cardiac structure and function, carotid intima-media thickness and plaque. Univariate and multivariate analysis were used to examine the association between BP and clinical parameters. Results 63.9% of CKD patients was non- dipper BP pattern, and 36.1% was dipper BP pattern. As compared to dipper BP patients, those with non-dipper BP had higher ratio of nighttime/daytime proteinuria （0.51 ±0.29 vs 0.42±0.21, P 〈 0.01）, lower estimated glomerular filtration rate （eGFR） [（56.2±48.2） vs （75.5-±56.5） ml. min-1. （1.73 m2）-1, P 〈 0.01], higher serum cystatin C[（2.8±2.0） mg/L vs （2.1±2.0） mg/L, P 〈 0.01], higher left ventricular mass index [（53.7± 23.2） vs （45.1± 16.3） g/m2, P 〈 0.01] and severely damaged left ventricular diastolic function and higher carotid intima-media thickness [（0.7±0.3） vs （0.6±0.2） mm, P〈 0.01]. Nighttime blood pressure was independent predictor for proteinuria, eGFR and left ventricular mass index. Conclusions Non- dipper blood pressure pattern is very common in CKD patients. Nighttime pressure is closely associated to renal damage and cardiovascular injuries.