清晨高血压在维持性血液透析患者中的检测及其临床意义

Measurement and clinical significance of morning hypertension in maintenance hemodialysis patients

目的了解维持性血液透析患者清晨高血压的发生率,并探讨其在维持性血液透析合并心血管并发症高发生率中的可能作用。方法选择53例透析龄≥6月的维持性血液透析患者,患者均为早班透析（治疗时间7~11Am）,每周透析3次,每次4h。根据患者在透析之前测量血压值,1周内3次血压测量取平均值,定义清晨高血压为平均收缩压〉140mm Hg（1mm Hg=0.133kpa）或者平均舒张压〉90mm Hg。收集患者一般资料,如年龄、透析龄、原发病因、性别、体质量和身高;生化指标,如肌酐、尿素氮、血钙、血磷、血全段甲状旁腺激素（intact parathyroid hormone,i PTH）、血红蛋白、白蛋白、C反应蛋白、氨基末端B型利钠肽前体。心脏超声数据,如左心室舒张末期内径、左心室后壁厚度、室间隔厚度等,计算左心室心肌质量指数（left ventricular mass,LVMi）,将患者是否合并清晨高血压分为2组,比较2组之间上述指标的差异。结果 53例患者中,男性31例,女性22例,平均年龄为（60.70±12.38）岁,平均透析龄为（5.96±5.15）年。其中31例检测符合清晨高血压,发生率为58.49%。将患者按照是否存在清晨高血压分为2组,比较各项指标后发现,仅LVMi 1项存在显著差异（111.62±20.71vs.132.40±36.77,P=0.012）。Pearson相关分析发现清晨收缩血压与LVMi密切相关（r=0.386,P=0.004）,而与其它各项指标均无显著相关关系。结论维持性血液透析患者的清晨高血压发生率较高,且清晨收缩血压与其左心室肥厚的发生显著相关。控制清晨高血压能一定程度上改善维持性血液透析患者的心血管并发症。

Objective To explore the occurrence of morning hypertension and its correlation with cardiovascular disease in maintenance hemodialysis（MHD） patients. Methods Fifty-three MHD patients dialyzed in the morning（7-11 am） were enrolled in this study. Blood pressure was measured before hemodialysis and the values measured in the 3 dialysis sessions in a week were averaged. The patients were then divided into two groups according to the blood pressure level： morning hypertension group（140/90 mm Hg） and morning normal pressure group（〈 140/90 mm Hg）. Medical history, blood biochemistry tests and echocardiogram were compared between the 2 groups by using t test. Results A total of 53 MHD patients（31 males and 22 females, 60.70±12.38 years of age, mean hemodialysis duration 5.96±5.15 years） were investigated. The prevalence of morning hypertension was 58.49%. Left ventricular mass index（LVMi） was significantly different between the two groups（132.40 ± 36.77 vs. 111.62 ± 20.71, P =0.012）. Pearson correlation analysis showed that morning systolic blood pressure was significantly correlated with LVMi（r=0.386, P=0.004）. Conclusion Morning hypertension occurred higher in hemodialysis patients and correlated with LVMi. Appropriate control of morning hypertension may be useful for the decrease of cardiovascular complications in MHD patients.