老年人杓型高血压晨峰现象与尿蛋白和肌酐的关系

Relationship between morning blood pressure surge and urinary albumin creatinine ratio in elderly patients with dipper essential hypertension

目的探讨老年杓型高血压患者血压晨峰（morningbloodpressuresurge，MBPS）现象与尿微量白蛋白／肌酐（UmAlb／Cr）的关系。方法273例老年杓型高血压患者，根据动态血压监测有无MBPS现象分为晨峰组106例及非晨峰组167例，均进行UmAlb／Cr检测，并常规检测血尿素、肌酐、血糖、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油、胆固醇，分析两组间UmAlb／Cr差异。结果两组患者在性别比、年龄、高血压病程、血尿素、肌酐、血糖、HDL-C、LDL-C、三酰甘油、胆固醇比较差异均无统计学意义（P〉0．05）。晨峰组与非晨峰组比较，MBPS变异幅度显著增高[（32．8±8．2）mmHg比（12．0±7．2）mmHg，P=0．003。晨峰组umAlb／cr高于非晨峰组（4．93±2．17比4．23±2．42，P=0．01），晨峰组不同性别UmAlb／Cr均高于非晨峰组（男性：4．95±1．96比2．98±2．05，P=0．001；女性：5．89±2．24比5．03±2．37，P=0．04）。结论老年杓型高血压患者MBPS现象对UmAlb／Cr增高产生重要影响，有晨峰现象高血压患者易早期发生肾功能损害。

Objective To investigate the relationship between morning blood pressure surge （MBPS） and urinary albumin/creatinine （UmAlb/Cr） ratio in elderly patients with dipper essential hypertension. Methods Totally 273 elderly patients with dipper essential hypertension were divided into MBPS group （observation group, n= 106） and non-MBPS group （control group, n-- 167） according to the presence or absence of MBPS. The urinary UmAlb/Cr ratio, blood urea nitrogen （BUN）, creatinine （Cr）, blood glucose （Glu）, high density Iipoprotein cholesterol （HDLC）, low density lipoprotein cholesterol （LDL-C）, triglyceride （TG） and cholesterol （TCH） were detected. The differences in UmAlb/Cr ratio between the two groups were analyzed. Results There were no statistical significances in sex ratio, age, course of hypertension, BUN, Cr, blood Glu, HDL-C, LDL-C, TG and TCH between the two groups （P〉0.05）. The amplitude of variation in morning systolic pressure peak was higher in MBPS group than in non MBPS group （（32.8±8.2） mmHg vs. （12.0±7.2） mm Hg,P〈0. 001. UmAlb/Cr ratio was higher in MBPS group than in non-MBPS group （4. 93±2.17） vs. （4.23±2.42）, P〈0. 059. There were significant differences in UmAlb/Cr ratio between MBPS group and non-MBPS group in different genders male： （4.95±1.96） vs. （2.98 ±2.05）, female： （5.89±2.24） vs. （5.03±2.37）, both P〈0.05. Conclusions MBPS has a great influence on UmAlb/Cr ratio and tends to cause early impairment Of renal function in elderly patients with dipper essential hypertension.