老年轻、中度高血压患者自主神经功能与早期肾损害的关系

The relationship between automatic nervous function and early renal dysfunction in elderly patients with mild-to-moderate essential hypertension

目的:探讨老年轻、中度原发性高血压患者自主神经功能与早期肾损害的关系。方法:选取2014-01-2016-09在民航总医院心内科门诊就诊的老年轻、中度原发性高血压患者223例。测定尿微量白蛋白(UAE)和尿肌酐(Cr),根据早期肾损害指标ACR(ACR=尿UAE/尿Cr×0.113)分为两组:ACR正常组109例,ACR升高组114例。所有患者均进行同步动态心电图及动态血压监测,记录心率变异性(HRV)及血压变异性(BPV)指标,比较两组患者HRV和BPV的差异。分别采用Pearson相关分析法与多元Logistic回归分析法,分析HRV和BPV指标与早期肾损害的相关性。结果:HRV指标:ACR升高组患者相邻RR间期大于50ms所占总心动次数的百分比(PNN50)、所有心搏RR间期均值的标准差(SDNN)和每5 min心搏RR间期均值的标准差(SDANN)均明显低于ACR正常组(均P<0.05);BPV指标:ACR升高组24h收缩压标准差(24hSSD)、白天收缩压标准差(dSSD)和夜间收缩压标准差(nSSD)均明显高于ACR正常组(均P<0.05)。多元Logistic回归分析结果显示:24h平均脉压(24hPP)、24hSSD、SDNN和SDANN与ACR均呈显著相关(均P<0.05)。结论:老年轻、中度原发性高血压患者部分HRV指标和部分BPV指标与ACR独立相关,提示交感神经兴奋与老年轻、中度原发性高血压患者早期肾损害密切相关。

Objective：To investigate the relationship between autonomic nervous function and early renal dysfunction in elderly patients with mild-to-moderate essential hypertension.Method：A total of 223 elderly patients with mild-to-moderate essential hypertension were enrolled in Civil Aviation General Hospital from January,2014 to september,2016.Urinary albumin excretion（UAE）and urinary creatinine（UCr）were measured in all elderly patients,who were divided into ACR（ACR =UAE/UCr×0.113）normal group（109）and high ACR group（114）via the results of ACR.Synchronic 24 hours ambulatory blood pressure monitoring and dynamic electrocardiogram were detected for all patients to simuiltaneously monitor the heart rate variability（HRV）and blood pressure variability（BPV）.The differences between the two groups were compared in HRV and BPV.Pearson single factor analysis and multivariate Logistic regression analysis were performed to define the relationship between ACR,HRV and BPV respectively.Result：The level of 24 hSSD,dSSD,nSSD and 24 hPP increased significantly（all P0.05）,while the level of PNN50,SDANN and SDNN decreased significantly（all P0.05）in high ACR group compared with normal ACR group.The level of 24 hSSD,dSSD and nSSD increased significantly in high ACR group compared with normal ACR group（P0.05）.Multiple linear regression analysis showed that ACR was positively correlated with 24 hSSD,24hPP,SDANN and SDNN（all P〈0.05）.Conclusion：HRV（SDANN,SDNN）and BPV（24hSSD,dSSD,nSSD）are positively correlated to ACR in patients with mild-to-moderate essential hypertension.Sympathetic activation is closely related with early renal dysfunction in elderly patients with mild-to-moderate essential hypertension.