原发性与继发性肾小球病患者24小时动态血压特点对比分析

Comparison analysis of 24 h ambulatory blood pressure monitoring between primary and secondary glomerular disease

目的探讨原发性肾小球病与继发性肾小球病患者24 h动态血压的差异,以指导临床个体化降压治疗。方法选择原发性肾小球病患者64例,均未行肾脏替代治疗,并随机选择与其年龄、性别、估测肾小球滤过率(eGFR)相匹配的继发性肾小球病患者57例,两组患者均行24 h动态血压监测。结果①继发性肾小球病组24 h平均收缩压、夜间平均收缩压和夜间收缩压负荷高于原发性肾小球病组,差异有统计学意义(P<0.05)。②两组患者血压变异性和晨峰血压差异无统计学意义(P>0.05)。③原发性肾小球病组39.0%为勺型血压,43.8%为非勺型血压,17.2%为反勺型血压;继发性肾小球病组10.5%为勺型血压,47.4%为非勺型血压,42.1%为反勺型血压;原发性肾小球病组异常血压类型比例为61.0%,继发性肾小球病组异常血压类型比例为89.5%,差异有统计学意义(P<0.05)。结论继发性肾小球病患者夜间收缩压控制较原发性肾小球病患者差,前者异常血压更顽固。建议针对继发性肾小球病患者夜间血压采取个体化治疗,有针对性地调整降压方案。

Objective To investigate the characteristics of 24 h ambulatory blood pressure monitoring of primary and secondary glomerular disease so as to guide the individual antihypertensive treatment in clinics. Methods Sixty-four patients with primary glomerular disease were selected, more of them not undergone renal replacement treatment. Besides, 57 patients with secondary glomerular disease matched with age, gender and estimated glomerular filtration rate （eGFR） were randomly selected. Twenty-four hour ambulatory blood pressure monitoring was carried out in both groups. Results （1）The 24 h mean systolic blood pressure, night mean systolic blood pressure and night systolic load in secondary glomerular disease group were significantly higher than those in primary glomerular disease group （ P 〈 0.05） . （2） There was no significant difference in blood pressure variability and morning surge between two groups （P 〉 0.05）. （3） In primary glomerular disease group, dipper blood pressure accounted for 39.0%, non-dipper blood pressure 43.8% and anti-dipper blood pressure 17.2%. In secondary glomerular disease group, dipper blood pressure accounted for 10.5%, non-dipper blood pressure 47.4% and anti-dipper blood pressure 42.1%. There were significant differences in the percentage of abnormal blood pressure between primary glomerular disease group and secondary glomerular disease group （61.0% vs 89.5%, P 〈 0.05）. Conclusion The control of night systolic blood pressure in patients with secondary glomerular disease is poorer than that in patients with primary glomerular disease, and abnormal blood pressure in secondary glomerular disease is much more resistant. It is advised to individualize the antihypertensive treatment of night systolic blood pressure in patients with secondary glomerular disease.