血压正常的2型糖尿病患者血压昼夜节律、血浆醛固酮、肾素及心钠素水平研究

Study on circadian rhythm,plasma aldosterone,renin and atrial natriuretic peptide in normotensive patients with type 2 diabetes

目的研究不伴高血压的新诊断2型糖尿病患者血压昼夜节律及肾素、血管紧张素、醛固酮(ADS)、心钠素水平。方法选取我院住院的2型糖尿病伴高血压患者(2DMH组)72例,我院住院或门诊新诊断2型糖尿病不伴高血压患者(2DM组)68例,体检中心健康体检者(C组)54例。对所有入选者进行24 h动态血压监测,观察昼夜血压的正常节律是否存在,记录24 h平均收缩压(24 hSBP)和舒张压(24 hDBP),日间平均收缩压(dSBP)和舒张压(dDBP),夜间平均收缩压(nSBP)和舒张压(nDBP),计算△MBP。并检测三组研究对象血浆肾素、血管紧张素、血浆醛固酮、心钠素水平。结果 2DM组血压昼夜节律消失者显著高于C组(47/68 vs 9/54,P<0.05),其中以24 hDBP、dDBP及nDBP显著升高(P<0.05)。2DM组PRA、AngⅡ、ADS均显著高于C组(P<0.05)。2DMH组PRA、AngⅡ、ADS显著高于2DM组(P<0.05)。2DMH组及2DM组ANP显著低于C组(P<0.05)。结论新诊断的不伴有高血压的2型糖尿病患者已有血压昼夜节律的紊乱且血清PRA、AngⅡ、ADS已开始升高。

Objective To explore the changes of circadian rhythm and renin, angiotensin, aldosterone （ADS）, atrial natriuretic peptide （ANP） levels in normotensive patients with newly diagnosed type 2 diabetes. Methods All subjects were selected from our hospital and divided into three groups：type 2 diabetes and hypertension group（ 2DMH group, n = 72 ）, newly diagnosed type 2 diabetes without hypertension group（2DM group, n = 68 ）, healthy control group （control group, n = 58 ）. The 24 h ambulatory blood pressure, normal circadian rhythm,24 h mean systolic blood pressure （24 hSBP） ,24 h diastolic blood pressure （24 hDBP）, average daytime systolic blood pressure（dSBP） ,average daytime diastolic blood pressure （dDBP） ,mean night-time systolic blood pressure （nSBP） and mean diastolic blood pressure （nDBP） were observed and recorded, and A MBP was calculated. And plasma renin, Ang II , ADS, ANP levels were detected in all three groups. Results In 2DM group,the incidence of circadian rhythm abnormalities of blood pressure was sig- nificantly higher than that in control group （47/68 vs 9/54, P 〈 O. 05 ）, and 24 hDBP, dDBP and nDBP were also significantly higher （P 〈 0.05 ）. In 2DM group, plasma renin activity（ PRA）, Ang II ADS levels were significantly higher than those in control group （P 〈 0.05 ）. In 2DMH group, PRA, Ang II , ADS were significantly higher than those in 2DM group （ P 〈 0.05 ）. ANP levels were significantly lower in 2DM group and 2DMH group than that in control group （P 〈 0.05）. Conclusion Normotensive patients with newly diag- nosed type 2 diabetes have circadian rhythm disorder and elevated PRA, Ang II , ADS levels.