不同阶段糖尿病肾病患者自主神经功能和昼夜血压、心率的变化

Autonomic Neuropathy and Circadian Blood Pressure Variation in Diabetic Patients With Various Stages Nephropathy.

探讨自主神经功能和昼夜血压、心率在不同阶段糖尿病肾病患者中的变化。采用 2 4h动态心电图和血压同步监测 38例正常对照组和 84例糖尿病患者 ,包括A组 (正常蛋白尿 ) 4 8例、B组 (微量蛋白尿 ) 2 0例、C组 (大量蛋白尿组 ) 16例。结果 :A组糖尿病患者已有夜间血压和心率增高 ,昼夜血压、心率下降幅度及部分心率变异指标的降低 ;随蛋白尿增多 ,上述指标异常加重 ,并出现白昼血压和心率增高。A、B、C组分别有 5 4 .17%、75 .0 0 %和 87.5 0 %的患者出现昼夜血压节律消失 ,而对照组仅有 2 1.0 5 %。结论 :糖尿病患者普遍存在自主神经病变 。

To study autonomic neuropathy and circadian blood pressure (BP) and heart rate (HR) in diabetic patients with various stages nephropathy,24 hour dynamic electrocardiography and ambulatory blood pressure monitoring were performed in 38 control subjects and 84 diabetic patients including group A (38 cases with normoalbuminuria),group B (20 cases with microalbuminuria),group C (16 cases with macroalbuminuria).Results:The mean night BP and HR were significantly higher and nocturnal BP and HR reduced in group A,as compared with control subjects;the heart rate variability (HRV) significantly reduced too.With increasing of albuminuria,the above abnormality of parameteres were aggravated,elevated day BP and day HR were seen in diabetic patients.Loss of circadian BP variation were 54.17%,75.00% and 87.50%,respectively in group A,B and C,and 21.5% in control group.Conclusion:Autonomic neuropathy were commonly existed in diabetic patients.Increased night BP and HR may be a early symbol of diabetic nephropathy.