慢性肾脏病患者动态血压参数及血压变异的特点分析

Features of ambulatory blood pressure and blood pressure variability in patients with chronic kidney disease

目的 分析慢性肾脏病（chronic kidney disease,CKD）患者动态血压参数与肾小球滤过率（GFR）及尿蛋白定量的相关性,并探讨血压变异性参数特点.方法 收集首次治疗的伴有高血压及蛋白尿的CKD患者70例.测量肾功能、24 h尿蛋白定量等生化检测结果,采用动态血压监测仪监测24 h血压并记录参数.根据GFR将患者分为CKD1~2期组和CKD3~5期组.根据24 h尿蛋白定量分为以下3组：Ⅰ组＜1.0 g,Ⅱ组1.0～3.5 g,Ⅲ组＞3.5 g.比较各组动态血压参数,并探讨监测结果与肾功能及蛋白尿的关系.结果 随着患者肾功能恶化,24 h收缩压、舒张压、脉压差、白昼收缩压、夜间收缩压等指标明显升高（P＜0.05）,且与GFR成负相关,白昼收缩压是GFR下降的独立危险因素.Ⅲ组的白昼舒张压（92.94±15.32）mm Hg明显高于Ⅰ组的（85.25±8.64）mm Hg（P＜0.05）.白昼舒张压与蛋白尿水平呈正相关（r=0.257,P=0.032）.所有患者舒张压变异性均明显高于收缩压变异性（P＜0.05）.结论 本研究样本中收缩压与肾功能恶化明显相关,白昼收缩压和舒张压分别与GFR下降及蛋白尿有关,舒张压变异性应受到更多重视.

Objective To explore the features of ambulatory blood pressure and blood pressure variability in patients with chronic kidney disease （CKD）. Methods A total of 70 initially diagnosed CKD patients with hypertension and proteinuria in our department were enrolled in this study. Ambulatory blood pressure was monitored. Serum creatinine, 24-h urinary protein quantitation and other biochemical parameters were measured regularly. According to GFR, patients were divided into CKD1-2 stage group and CKD3-5 stage group. In the light of 24-h urinary protein quantitation, patients were divided into three groups., group Ⅰ （〈1.0 g）, group Ⅱ （1.0-3. 5 g）, group Ⅲ （〉3.5 g）. Results With the deterioration of renal function, 24-h systolic blood pressure, diastolic blood pressure, pulse pressure, daytime systolic blood pressure, nighttime systolic blood pressure and other indicators were significantly increased, and these indicators were negatively correlated with GFR. Daytime systolic blood pressure was an independent risk factor for GFR decline. The daytime diastolic blood pressure in group Ⅲ[（92. 94 ± 15.32） mmHg] was significantly higher than in group Ⅰ [（85.25 ± 8. 64） mmHg] （P〈0. 05）. Daytime diastolic blood pressure level was positively correlated with proteinuria （r = 0. 257,P = 0. 032）. The diastolic blood pressure variability was higher than the systolic blood pressure variability in all patients （P〈0. 05）. Conclusions Systolic blood pressure is significantly associated with deterioration of renal function. Daytime systolic and diastolic blood pressure is associated with the decline of GFR and proteinuria, respectively. More attention should be paid to diastolic blood pressure variability.