非透析慢性肾脏病合并血压变异患者大动脉僵硬度分析

Analysis on relationship between stiffness of large artery and variability of blood pressure in patients with chronic kidney disease without dialysis

目的探讨非透析慢性肾脏病（CKD）患者血压变异性与大动脉僵硬度的关系。方法选取2010年4月至2014年4月诊断为CKD 3~5期非透析患者,检测24 h动态血压,根据患者是否患有高血压以及血压变异性进行分组,分析各组各项指标的差异以及血压变异性与大动脉僵硬度的关系。结果共收集CKD合并高血压患者368例,CKD血压正常患者64例。直线相关分析发现CKD合并高血压患者血压变异性与脉搏波传导速度（PWV）呈显著的负相关（r=-0.583,P〈0.05）。CKD血压正常患者血压变异性与PWV呈显著的负相关（r=-0.844,P〈0.05）。多元线性回归分析患者各项观察指标与患者PWV的关系发现,CKD合并高血压患者收缩压、舒张压、脉压、血压变异性、CKD分期与患者PWV显著相关;CKD血压正常患者血压变异性和CKD分期与患者PWV显著相关。结论 CKD患者是否合并高血压,其血压的昼夜异常变化与患者大动脉僵硬度关系密切。

Objective To explore the relationship between variability of blood pressure and stiffness of large artery in patients with chronic kidney disease（ CKD） without dialysis. Methods Patients with CKD at phase 3 ~ 5 without dialysis admitted in the department of internal medicine in this hospital during April 2010 to April 2014 were allocated in this study. Twenty four hours dynamic blood pressure had been examined,and patients were grouped according to whether they suffered from high blood pressure and variability of blood pressure. The difference in each index of each group and the relationship between variability of blood pressure and stiffness of large artery had been analyzed. Results There were368 patients with CKD and hypertension and 64 patients with CKD were allocated for this study. There was significant negative correlation between variability of blood pressure and PWV in patients with CKD and hypertension examined by linear correlation analysis（ r =- 0. 583）. There was significant negative correlation between variability of blood pressure and PWV in patients with CKD（ r =- 0. 844）. The analysis with multiple linear regression showed that there was significant correlation between PWV and systolic blood pressure,diastolic blood pressure,pulse pressure,variability of blood pressure and CKD staging in patients with CKD and hypertension. There was also significant correlation between PWV,variability of blood pressure and CKD staging in patients with CKD. The variability of blood pressure was closely correlated with stages of CKD and PWV in CKD patients with normal blood pressure. Conclusion There is close relationship between circadian variation of blood pressure and stiffness of large artery,whether patients with CKD suffered from hypertension or not.