反勺型血压对慢性肾脏病患者靶器官损伤的影响

Influence of reversed dipper blood pressure pattern on target organ damage in patients with chronic kidney disease

目的：探讨中国慢性肾脏病（CKD）患者反勺型血压与靶器官损害的关系。方法选择2010年5月至2014年4月中山大学附属第三医院肾内科的CKD患者1116例为研究对象，使用携带式动态血压计监测动态血压，收集血压及相关临床指标等资料，彩色超声检查评价心脏结构和功能改变。结果 CKD患者反勺型血压占23.39%，非勺型血压46.95%，勺型血压27.15%。与勺型及非勺型血压患者相比，反勺型血压患者左室质量指数显著增高（P＜0.0083），肾小球滤过率和左室舒张功能显著下降（均P＜0.0083）。多因素回归分析结果显示，反勺型血压是CKD患者肾小球滤过率下降和左室质量指数增加的独立危险因素；年龄、血红蛋白及合并糖尿病是反勺型血压的独立影响因素。结论反勺型血压是中国CKD患者常见的血压模式之一，反勺型血压患者靶器官损伤更显著。

Objective To explore the relationship between reversed dipper blood pressure （BP） pattern with target organ damage in Chinese chronic kidney disease （CKD） patients. Methods A total of 1 116 CKD patients from the Third hospital of Sun Yat-sen university were enrolled from May 2010 to April 2014, all of whom carried ambulatory blood pressure monitoring （ABPM）, and clinical data and ultrasonography were collected. Results Total of 23.39% CKD patients were reversed dipper BP pattern, 46.95% patients were non-dipper BP pattern, and dipper BP pattern was only 27.15%. Compared with dipper and non-dipper BP pattern group, patients with reversed dipper BP pattern had higher left ventricular mass index （LVMI）, lower estimated glomerular filtration rate （eGFR） and severely damaged left ventricular diastolic function （all P〈0.0083）. After multiple linear regression analysis, reversed dipper BP pattern was an independent predictor for determining eGFR and LVMI. Age, lower hemoglobin and combination of diabetes were independently associated with reversed dipper BP pattern. Conclusion Reversed dipper BP pattern is common in Chinese CKD patients, which is closely related to renal damage and cardiovascular injuries.