不同阶段慢性肾脏病患者动态血压变化规律研究

Variation Characteristics of Ambulatory Blood Pressure at Different Stages of Chronic Kidney Disease

目的探讨不同阶段慢性肾脏病(CKD)患者动态血压的变化规律。方法选择2012年7—12月广西医科大学第四附属医院住院及门诊收治的CKD患者149例,根据肾小球滤过率(GFR)分组,GFR≥60 ml·min-1·(1.73 m2)-1为早期组(n=46)、15 ml·min-1·(1.73 m2)-1≤GFR<60 ml·min-1·(1.73 m2)-1为中期组(n=54)、GFR<15 ml·min-1·(1.73 m2)-1为晚期组(n=49);将该院同期30例体检健康者作为对照组。分别测量各组受试者诊室血压及24 h动态血压,记录相关指标进行比较分析。结果 149例CKD患者中诊室血压升高58例(38.9%),24 h动态血压升高74例(49.7%),非杓型血压91例(61.1%)。4组受试者诊室血压升高、动态血压升高及非杓型血压发生率比较:晚期组均高于中期组,中期组均高于早期组,早期组均高于对照组(P<0.05)。日间平均收缩压(dSBP)、日间平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)比较:晚期组均高于中期组,中期组均高于早期组,早期组均高于对照组(P<0.05);夜间血压下降率比较:晚期组均低于中期组,中期组均低于早期组,早期组均低于对照组(P<0.05)。结论 CKD患者中高血压发生率较高且控制不良,不同阶段CKD患者的血压升高程度及非杓型血压发生率随着肾功能减退逐渐升高。

Objective To explore the variation characteristics of ambulatory blood pressure（ ABP） at different stages of chronic kidney disease（ CKD）. Methods A total of CKD 149 patients admitted to this hospital from July to December in 2012 were divided,according to glomerular filtration rate（ GFR）,into groups A 〔at early stage,n = 46,GFR ≥60 ml · min^-1·（ 1. 73 m^2）^-1〕,B 〔at medium stage,n = 54,15 ml·min^-1·（ 1. 73 m^2）^-1≤GFR 60 ml·min^-1·（ 1. 73 m^2）^-1〕,C 〔at terminal stage,n = 49,GFR 15 ml·min^-1·（ 1. 73 m^2）^-1〕. And 30 healthy subjects were enrolled as control group. Clinic blood pressure（ BP）,24 h ambulatory blood pressure（ ABP） were measured,related indicators were analyzed comparatively. Results In the 149 patients,58 had increased clinic BP（ 38. 9%）,74 had increased ABP（ 49. 7%）, 91 had non-dipper BP（ 61. 1%）. The incidences of increased BP,ABP,non-dipper BP were higher in group C than in group B,higher in group B than in group A,higher in group A than in group control（ P〈0. 05）. The mean daytime SBP and DBP,mean nighttime SBP and DBP were higher in group C than in group B,higher in group B than in group A,higher in group A than in group control（ P〈0. 05）. The BP decrease rate was lower in group C than in group B,lower in group B than in group A,lower in group A than in group control（ P〈0. 05）. Conclusion The hypertension incidence is high and poorly controlled in CKD patients. The BP level and non-dipper BP incidence increase gradually with renal dysfunction.