2型糖尿病患者血压昼夜节律变化与肾功能的相关性

Relationship between circadian rhythm of blood pressure and renal function in patients with type 2 diabetes mellitus

目的探讨未合并高血压的2型糖尿病(T2DM)患者血压昼夜节律变化与肾功能的相关性。方法入选符合纳入标准的T2DM患者91例,所有患者均进行24 h动态血压监测(ABPM),按夜间血压下降率分为反杓型组(夜间血压下降率<0,n=27),非杓型组(0≤夜间血压下降率<10%,n=36)和杓型组(10%≤夜间血压下降率<20%,n=28),并同时测量各组肾功能指标。结果三组患者Scr、BUN组间比较,差异均无统计学意义(P>0.05);Cys C、UMA组间比较,反杓型组和非杓型组均高于杓型组,差异均有统计学意义(P<0.05);而反杓型组与非杓型组比较,差异无统计学意义(P>0.05)。结论T2DM患者血压昼夜节律异常可能导致早期肾功能损害。

Objective To investigate the relationship between circadian rhythm of blood pressure and renal function in type 2 diabetes mellitus patients without hypertension. Methods A total of 91 patients with T2DM met the inclusion criteria. All patients were moni- tored for 24 h ambulatory blood pressure, and divided into anti-dipper group（ descent rate of nighttime blood pressure 〈 0, n = 27 ）, nondipper group（0 ≤ descent rate of nighttime blood pressure 〈 10%, n = 36） and dipper group （ 10% ≤ descent rate of nighttime blood pressure 〈 20% ,n = 28）. The kidney function was evaluated in all patients. Results There was no statistically significant difference in serum creatinine and blood urea nitrogen among three groups（ P 〉 0.05 ）. Levels of cystatin C and urine microalbumin were higher in anti-dipper group and non-dipper group than that in dipper group （ P 〈 0.05 ）, but there was no statistically significant difference be- tween anti-dipper group and non-dipper group （P 〉 0.05）. Conclusion Abnormal circadian rhythm of blood pressure may cause early kidney damage in patients with T2DM.