维持性血液透析患者血压变异性与左心室肥厚的相关性分析

Correlation between Blood Pressure Variability and Left Ventricular Hypertrophy in Patients with Maintenance Hemodialysis

目的探讨维持性血液透析患者血压变异性与左心室肥厚的关系。方法选取2014年1月至2015年12月北京市昌平区中西医结合医院收治的104维持性血液透析患者作为维持性血液透析组,并选取同时期收治的100例单纯高血压患者作为对照组,两组患者均行24 h动态血压监测,根据24 h收缩压变异系数(24 h SBPCV)将维持性血液透析组患者分为高24 h SBPCV组(n=48)和低24 h SBPCV组(n=56)。观察各组患者血压变异情况、左心室肥厚以及血压昼夜节律类型分布情况,比较维持性血液透析组患者血压变异性与左心室肥厚的相关性。结果高24 h SBPCV组的24 h收缩压变异性、24 h舒张压变异性、白昼收缩压变异性、白昼舒张压变异性、夜间收缩压变异性、夜间舒张压变异性、收缩压变异系数、舒张压变异系数均高于低24 h SBPCV组和对照组[依次为(17.6±4.2)mm Hg(1 mm Hg=0.133 k Pa)比(14.1±3.4)mm Hg、(12.2±2.8)mm Hg,(13.2±2.7)mm Hg比(11.3±2.2)mm Hg、(9.7±1.9)mm Hg,(16.3±3.1)mm Hg比(13.8±2.1)mm Hg、(11.9±1.6)mm Hg,(12.8±2.4)mm Hg比(10.7±2.5)mm Hg、(9.5±2.2)mm Hg,(13.5±2.9)mm Hg比(11.2±3.6)mm Hg、(9.8±3.2)mm Hg,(11.9±2.4)mm Hg比(10.7±2.9)mm Hg、(9.3±2.6)mm Hg,(14.1±2.5)%比(10.4±1.7)%、(8.2±1.8)%,(10.4±1.9)%比(9.3±1.5)%、(8.1±1.3)%](P<0.05),低24 h SBPCV组各指标高于对照组(P<0.05);高24 h SBPCV组患者左心室肥厚发生率、左心室质量指数明显高于低24 h SBPCV组和对照组(P<0.05),而低24 h SBPCV组与对照组比较,差异无统计学意义(P>0.05);高24 h SBPCV组患者非杓型比例高于低24 h SBPCV组和对照组(P<0.05),而低24 h SBPCV组与对照组比较,差异无统计学意义(P>0.05);维持性血液透析组患者24 h收缩压变异性和24 h舒张压变异性与左心室肥厚均呈正相关(P<0.05)。结论维持性血液透析患者较高血压患者存在明显的血压变异性,且24 h收缩压变异性和24 h舒张压变异性与左心室肥厚均呈正相关。

Objective To investigate the correlation between blood pressure variability and left ventricular hypertrophy in patients with maintenance hemodialysis. Methods A total of 104 maintenance hemodialysis patients admitted to eijing Changping District Integrated TCM-WM Hospital from Jan. 2014 to Dec. 2015 were included as a maintenance hemodialy- sis group ,and 100 cases of simple hypertension during the same period were included as a control group, and both groups were given the 24 h ambulatory blood pressure monitoring. The maintenance hemodialysis group was divided into a high 24 h SBPCV group （ n = 48） and a low 24 h SBPCV group （ n = 56） according to the 24 h systolic blood pressure coefficient of variation（24 h SBPCV）. The Blood pressure variability,left ventricular hypertrophy and blood pressure circadian rhythm were compared. Results The 24 h systolic blood pressure variabihty,24 h diastolic blood pressure variability,day systolic blood pressure variability, day diastolic blood pressure variability, nocturnal systolic blood pressure variability, nocturnal diastolic blood pressure variability, systolic blood pressure coefficient of variation and diastolic blood pressure coefficient ofvariation of the high 24 h SBPCV group were all higher than those of the low 24 h SBPCV group and the control group [ （ 17. 6 ±4. 2） mmHg vs （ 14. 1 ± 3.4） mmHg vs （ 12. 2 ± 2. 8） mmHg, （ 13. 2 ± 2. 7） mmHg vs （ 11.3 ± 2.2） mmHg vs （9.7±.9） mmHg,（16.3 ±.1） mmHg vs （13.8 ±2. 1） mmHg vs （11.9 ± 1.6） mmHg,（12.8 ±2.4） mmHg vs （10.7±2.5） mmHg vs （9.5±2.2） mmHg,（13.5 ±2.9） mmHg vs （11.2±3.6） mmHg vs （9.8±3.2） mmHg,（ll.9 ± 2.4） mmHg vs （10.7 ±2.9） mmHg vs （9.3 ±2.6） mmHg,（14. 1 ±2.5）% vs （10.4 ±1.7）% vs （8.2 ±1.8）%, （ 10. 4 ±1.9） % vs （9. 3 ± 1.5 ） % vs （8. 1 ± 1.3 ） % ] （ P 〈 0. 05 ）, each index in low 24 h SBPCV group was higher than those in control group （ P 〈 0. 05 ）. The incidence of left ventricular hypertrophy and left ventricular mass index in the high 24 h SBPCV group were significantly higher than those of the low 24 h SBPCV group and the control group （ P 〈 O. 05 ）, there were no significant differences between the low 24 h SBPCV group and the control group（ P 〉 0. 05 ）. The proportion of non-dipper hypertension in the high 24 h SBPCV group was significantly higher than that of the low 24 h SBPCV group and the control group（P 〈0. 05） ,while there was no significant difference between the low 24 h SBPCV group and the control group （P 〉0. 05）. The 24 h systolic blood pressure variability,24 h diastolic blood pressure variability and left ventricular hypertrophy in maintenance hemodialysis patients were significantly positively correlated（P 〈 0. 05 ）. Conclusion There is significant blood pressure variability in maintenance hemodialysis patients with hypertension, and there is a significant posi- tive correlation of 24 h systolic blood pressure variability and 24 h diastolic blood pressure variability with left ventricular hypertrophy.