高血压患者尿微量白蛋白/肌酐比值与动态血压水平及血压变异性的关系

Relationship among ratio of urinary micro albuminuria to creatinine, ambulatory blood pressure level and blood pressure variability in hypertensive patients

目的探讨高血压患者尿微量白蛋白/肌酐比值（UACR）与动态血压水平和血压变异性（BPV）的关系。方法入选2014年6月-2015年6月于河南中医学院第一附属医院心血管内科就诊的原发性高血压患者90例,其中男性57例,女性33例,平均年龄（41.2±6.3）岁。根据测定的UACR分为两组,对照组（UACR〈30 mg/g,n=52）和微量白蛋白尿组（30 mg/g≤UACR〈300 mg/g,n=38）。比较两组患者24 h平均收缩压及其标准差、24 h平均舒张压及其标准差、昼间平均收缩压及其标准差、昼间平均舒张压及其标准差、夜间平均收缩压及其标准差、夜间平均舒张压及标准差,以血压标准差及变异系数作为血压变异性指标。分析高血压患者UACR与BPV之间的相关性。结果与对照组比较,微量白蛋白尿组高血压病程延长,差异有统计学意义（P〈0.05）。与对照组比较,微量白蛋白尿组24 h平均收缩压和舒张压、日间平均收缩压和舒张压、夜间平均舒张压均升高,差异有统计学意义（P均〈0.05）。微量白蛋白尿组较对照组24 h收缩压标准差及其变异系数、日间收缩压标准差及其变异系数均升高,差异有统计学意义（P均〈0.05）。结果显示,24 h平均舒张压（β=0.202,P=0.007）、24 h收缩压标准差（β=0.986,P=0.001）与UACR呈正相关。24 h舒张压标准差与UACR水平无显著的相关性。结论原发性高血压患者24 h平均舒张压和24 h收缩压标准差与UACR水平升高显著相关。

Objective To investigate the relationship among ratio of urinary micro albuminuria（U-m Alb） to creatinine（Cr, UACR）, ambulatory blood pressure（BP） level and blood pressure variability（BPV） in hypertensive patients. Methods The patients with primary hypertension（n=90, male 57, female 33 and average age=41.2±6.3） were chosen from Jun. 2014 to Jun. 2015, and then divided into control group（UACR30 mg/g, n=52） and U-m Alb group（30 mg/g≤UACR〈300 mg/g, n=38） according to detected UACR. The changes of 24-h mean systolic blood pressure（SBP） and standard deviation, 24-h mean diastolic blood pressure（DBP） and standard deviation, daytime mean SBP and standard deviation, daytime mean DBP and standard deviation, nighttime mean SBP and standard deviation and nighttime mean DBP and standard deviation were compared in 2 groups. The standard deviations of BP and variation coefficient were taken as indexes of BPV. The correlation between UACR and BPV was analyzed in hypertensive patients. Results The course of hypertension was longer in U-m Alb group than that in control group（P〈0.05）. Compared with control group, 24 h mean SBP and DBP, daytime mean SBP and DBP and nighttime mean DBP increased in U-m Alb group（all P〈0.05）. Compared with control group, 24 h SBP standard deviation and variation coefficient and daytime SBP standard deviation and variation coefficient increased in U-m Alb group（all P〈0.05）. The results showed that 24 h mean DBP（β=0.202, P=0.007） and 24 h SBP standard deviation（β=0.986, P=0.001） were positively correlated to UACR, and 24 h DBP standard deviation was not correlated to UACR. Conclusion The 24 h mean DBP and 24 h SBP standard deviation is significantly correlated to increase of UACR level in patients with primary hypertension.