伴有高血压的非透析慢性肾脏病患者血压昼夜节律的特点

Features of Circadian Blood Pressure Rhythm in Hypertensive Patients with Non-dialysis Chronic Kidney Disease

目的：探讨伴有高血压的非透析慢性肾脏病患者血压昼夜节律特点及影响因素。方法：选取2014年5月~2014年11月在广州市第一人民医院肾内科就诊的193例非透析慢性肾脏病合并高血压的患者,以携带式动态血压计进行动态血压监测,同时检测血尿酸、肌酐、尿素氮、血离子、血脂、血红蛋白、甲状旁腺激素等生化指标。用超声心动图检查评价心脏结构和功能改变,高频超声评价颈部血管中膜厚度及斑块情况。采用单因素及多因素Logistic回归分析血压昼夜节律异常的相关影响因素。结果：血压昼夜节律正常（即杓型血压）占11.4%（22例）,血压昼夜节律异常中非杓型血压占57.5%（111例）、反杓型血压占26.9%（52例）、超杓型血压占4.1%（8例）;与杓型血压相比,血压节律异常患者钙拮抗剂服用比例、血肌酐、全段甲状旁腺素、尿酸、高密度脂蛋白、血红蛋白、夜间平均收缩压和舒张压较高、肾小球滤过率（e GFR）水平显著降低。Logistc回归分析显示,血压昼夜节律异常与甲状旁腺素水平（OR：7.22,95%CI：0.98~53.4,P=0.049）呈正相关。结论：伴有高血压的非透析慢性肾脏病患者血压昼夜节律异常最为常见,发生率为88.6%,甲状旁腺素水平与患者血压昼夜节律异常显著相关。

Objective：To investigate the features and associated factors of circadian blood pressure（BP）rhythm in hyper-tensive patients with non - dialysis chronic kidney disease. Methods：A total of 193 non - dialysis CKD patients accompanied by hy-pertension from May 2014 and November 2014 in our hospital were recruited and underwent 24 h - ambulatory blood pressure monito-ring. Blood uric acid,creatinine,urea,blood ions and lipids,hemoglobin,immunoreactive parathlyroid hormone（iPTH）and other clinical parameters were measured regularly. Ultrasonography was used to evaluate cardiac structure and function,carotid media thick-ness and plaque. Univariate and multivariate logistic analysis were used to examine the association between BP and clinical parame-ters. The associated factors of circadian blood pressure rhythm were determined by univariate and multivariate logistic regression analy-sis. Results：Normal circadian BP（dipper BP）profile was 11. 4% ,Abnormal circadian BP profile including non - dipper profile in 57. 5% of patients,an reversed dipper profile in 26. 9% and an extreme dipper in 4. 1% . As compared to dipper BP patients,those with abnormal circadian BP had higher ratio of CCB drug,serum creatinine,iPTH,uric acid,high density lipoprotein,hemoglobin, average systolic and diastolic blood pressure at night,lower estimated glomerular filtration rate. Multivariate logistic regression analysis showed that iPTH was the associated factor for circadian rhythm abnormality in hypertensive patients with non - dialysis chronic kidney disease. Conclusion：An abnormal circadian BP profile was 88. 6% ,which was common in hypertensive patients with non - dialysis chronic kidney disease. The negatively associated factor for abnormal BP rhythm among these people was iPTH.