长、短时血压变异对老年人群肾小球滤过率的影响

The impact of long- and short.time blood pressure variability on glomerular filtration rate in elderly population

目的探讨长、短时血压变异对老年人肾小球滤过率（glomeruar filtration rate，GFR）的影响。方法2006年6月至2007年10月第1次对开滦集团公司在职及离退休职工进行健康体检，此后分别于2008年6月至2009年10月、2010年6月至2011年10月和2012年6月至2013年10月进行了第2、3、4次健康体检，并于第3次体检时随机分层抽取年龄≥60岁的开滦集团离退休员工2814名进行动态血压监测等检查，最终入选符合标准的老年人2464名。长时收缩压变异（systolic blood pressure variability，SBPV）：以5次年度收缩压值为基础计算年度间收缩压的标准差，即年度间SBPV。短时SBPV：以日间收缩压标准差为日间SBPV，夜间收缩压标准差为夜间SBPV。采用多元线性回归分析年度间、日间和夜间SBPV对GFR估计值（eGFR）的影响及其相关性。结果在2464名入选者中，年度间血压及eGFR资料完整者2279例为长时血压变异组，24h动态血压及eGFR资料完整者1636名为短时血压变异组，年度间血压、24h动态血压、eGFR资料完整者1632名为长、短时血压变异组。分别按不同长、短时血压变异的中位数进一步分组（小于中位数为第1组，大于等于中位数为第2组），长时血压变异组中，年度间SBPV组的第1、2组eGFR分别为83．19、81．49m1．min^-1·1．73m^-2；短时血压变异组中，日间SBPV组的第1、2组eGFR分别为83．53、80．81ml·min^-1·1．73m^-2，夜间SBPV组的第1、2组eGFR分别为83．20、81．14ml·min^-1·1．73m^-2；长、短时血压变异组中，年度间SBPV组的第1、2组eGFR分别为83．21、81．08ml·min^-1·1．73m^-2，日间SBPV组的第1、2组eGFR分别为83．53、80．75ml·min^-1·1．73m^-2，夜间SBPV组的第1、2组eGFR分别为83．18、81．11ml·min^-1·1．73m^-2，各自组内第1组eGFR与第2组比较差异均有统计学意义（P均〈0．05）。影响eGFR的多元线性回归分析结果显示校正了可能的混杂因素后，长、短时血压变异组日间SBPV每增加1mmHg（1mmHg=0．133kPa），eGFR降低0．21ml·min^-1·1．73m^-2。结论老年人群日间SBPV增加可引起GFR下降。临床试验注册号中国临床试验注册中心，注册号为ChiCTR—TNC-11001489。

Objective To investigate the impact of long-time and short-time blood pressure variability （BPV） on glomerular filtration rate （eGFR） in elderly population. Methods A total of 2 464 participants aged of ≥60 years old without history of stroke and coronary heart disease were selected with random sampling method from the individuals underwent health check up in Tangshan Kailuan Hospital, Kailuan Linxi Hospital, Kailuan Zhaogezhuang Hospital between 2006 and 2013. The study participants were asked to join a face-to-face interview every two years. Long-time BPV was defined as the standard deviation of all SBP values at the baseline visit and following visits, short-time BPV was defined as the standard deviation of day time blood pressure and night time blood pressure which was derived from 24 hours ambulatory blood pressure monitoring. Multivariate linear regression models were used to test the impact of long- and short-time BPV on eGFR. Results The study included 3 participants groups including the long- time SBPV group （2 279 participants）, the short-time SBPV group （1 636 participants） and the long- plus short-time SBPV group （1 632 participants ）. Participants were further sub grouped by median value （ NO. 1 〈 meadian and NO. 2 〉 median value）, eGFR in the long-time SBPV NO. 1 and NO. 2 group was 83. 19 and 81.49 ml · min^-1 · 1.73 m^-2 respectively, in the short time SBPV NO. 1 and NO. 2 group was 83.53 and 80. 81 ml · min^-1 · 1.73 m^-2 of the day time, and was 83.20 and 81.14 ml · min^-1 · 1.73 m^-2 of the night time, respectively, eGFR in the long- plus short-time SBPV NO. 1 and NO. 2 group was 83.21 and 81.08 ml · min^-1 · 1.73 m^-2 of the long-time SBPV, and was 83.53 and 80. 75 ml · min^-1 · 1.73 m^-2 of the day time, and was 83. 18 and 81.11 ml · min^-1 · 1.73 m^-2 of the night time. Significant linear relationship was found between higher day time SBPV and lower eGFR （ P 〈 0. 05 ）. After adjusting for confounding parameters including age, sex, body mass index, 1 mmHg（ 1 mmHg =0. 133 kPa） of day time SBPV increase was related 0. 21 ml · min^-1 · 1.73 m^-2 eGFR decrease （ P 〈 0. 05 ）. Conclusion The higher day time SBPV is associated with reduced eGFR in the elderly population. Clinical Trail Registry Chinese Clinical Trial Registry, ChiCTR-TNC-11001489.