老年原发性高血压合并2型糖尿病患者动态血压监测的临床研究

Clinical Research of Ambulatory Blood Pressure Monitoring in Elderly Patients with Primary Hypertension Combined with Type 2 Diabetes

目的对老年原发性高血压合并2型糖尿病患者行24 h动态血压监测,观察血压水平及节律变化,探讨其与靶器官损害的相关关系。方法收集本院老年病房原发性高血压病合并2型糖尿病住院患者117例,对所有患者行24 h动态血压监测及空腹血清葡萄糖、糖化血红蛋白、血脂、血清尿酸、肾功能及尿微量蛋白5项检测,根据动态血压监测结果将患者分为杓型组(24例)及非杓型组(93例),并对2组患者临床指标进行比较。结果 2组患者年龄和靶器官损害发生率方面,非杓型组显著高于杓型组,差异有统计学意义(P<0.01);非杓型组夜间平均收缩压及夜间收缩压负荷均显著高于杓型组,差异有统计学意义(P均<0.01);非杓型组收缩压及舒张压夜间血压下降率显著低于杓型组,差异有统计学意义(P<0.001);2组患者空腹血清葡萄糖、糖化血红蛋白、血脂、血尿酸、血肌酐、尿素氮、血清胱抑素及肾小球滤过率无统计学差异(P>0.05);2组患者尿微量蛋白5项指标(α1-MG、β2-MG、微量蛋白、转铁蛋白、IGg)非杓型组均显著高于杓型组,差异有统计学意义(P均<0.01)。结论老年原发性高血压合并2型糖尿病患者高龄较多,血压升高以非杓型较为多见,与杓型高血压患者比较常合并有多项靶器官损害。动态血压监测结合尿微量蛋白5项指标(α1-MG、β2-MG、微量蛋白、转铁蛋白、IgG)对于老年原发性高血压合并2型糖尿病患者预测早期靶器官损害具有重要的临床意义。

Objective To observe the blood pressure level and the change of rhythm in senile patients with essential hypertension combined with type 2 diabetes, and explore their correlation with target organ damage. Methods A toral of 117 cases of essential hypertension combined with type 2 diabetes were recruited for the study, all patients received 24 h ambulatory blood pressure monitoring, as well as fasting serum glucose, glycosylat- ed hemoglobin, blood lipid, serum uric acid and renal function and urinary micro protein 5 items. The patients were divided into the dipper group （ 24 cases） and non-dipper group （93 cases）. Results The incidence of target organ damage in non-dipper group was significantly higher than dip- per group, and the difference was statistically significant （P 〈 0.01 ）. In addition, Non-dipper group showed significantly higher average night systolic blood pressure and night systolic blood pressure load than dipper group （P〈 0.01 ） ; Night systolic blood pressure reduction rates and night diastolic blood pressure reduction rates of Non-dippe group was significantly lower than dipper group （ P 〈 0.001 ） ; no significant difference was found be- tween the two groups about fasting serum glucose, glycosylated hemoglobin, blood lipid, blood uric acid, serum creatinine and urea nitrogen, and glo- merular filtration. The urine micro protein 5 was significantly higher in non-dipper group than in dipper group （ c~ I-MG, PI〈 0.01 ; [32-MG, P2 〈 0.01 ; MA, P3〈 0.001 ; TRF, P4 〈 0.001 ; IgG, P5 〈 0.001 ）. Conclusion Advanced age patients and non -dipper type hypertension were more common in elderly patients with essential hypertension combined with type 2 diabetes. Compared with dipper hypertension, non-dipper often com- bined with multiple target organ damage. For elderly patients with primary hypertension combined with type 2 diabetes mellitus, ambulatory blood pressure monitoring combined with urinary protein five has important clinical significance in prediction of early target organ damage.