持续不卧床腹膜透析患者血压昼夜节律的影响因素及其与残余肾功能和心功能的关系

The influence factors of blood pressure circadian rhythm in peritoneal dialysis patients and its relationship with residual renal function and cardiac function

目的观察持续不卧床腹膜透析（CAPD）患者血压昼夜节律的特点及影响因素，探讨其对残余肾功能（RRF）及心功能的影响。方法前瞻性收集2016年6月至2017年3月间于唐山地区各腹膜透析中心治疗3个月以上且合并高血压的持续不卧床腹膜透析（CAPD）患者120例作为研究对象。根据动态血压监测（ABPM）的血压昼夜节律情况，分为血压节律正常组和血压节律异常组；分别采集病史、检测相关化验指标、心脏超声。根据相关公式计算残余肾功能（RRF）、左室心肌质量指数（LVMi）及E／A、EF。采用单因素及多因素非条件Logistic回归分析影响血压昼夜节律异常的危险因素，采用逐步多重线性回归分析影响残余肾功能及心功能的危险因素。结果CAPD患者血压节律正常组14例（11．7％），血压节律异常组106例（88．3％），其中非杓型血压占75例（62．5％）。单因素及多因素非条件Logistic回归分析显示在较正性别及年龄后，影响血压昼夜节律异常的危险因素为：血尿酸（OR=1．197，95％CI：1．099-1．441）、CRP（OR=I．170，95％CI：1．061～1．331）和残余肾功能（OR=I．389，95％CI：1．160～1．779）。采用逐步多重线性回归分析影响残余肾功能及心功能的危险因素，残余肾功能与左室心肌质量指数、夜间收缩压下降率、超滤量呈负相关；左室心肌质量指数（心功能）与24h平均收缩压呈正相关，与夜间收缩压下降率、残余肾功能呈负相关，即血压昼夜节律异常可能导致残余肾功能及心功能下降。结论血尿酸、CRP和残余肾功能可能影响CAPD患者血压昼夜节律，同时血压昼夜节律异常可能导致残余肾功能及心功能下降。因此重视ABPM的监测和控制，能够更好地保护残余肾功能及改善心功能，从而延长和提高CAPD患者的生存时间及生存质量。

Objective Observed the characteristics and influence factors of blood pressure circadian rhythm in continuous ambulatory peritoneal dialysis patients. To investigate the effect of residual renal function and cardiac function. Methods Prospectively collected 120 eases of continuous ambulatory peritoneal dialysis from June 2016 to March 2017 in Tangshan renal medicine dialysis centers, who combined with hypertension were treated with peritoneal dialysis for more than 3 months. According to the dynamic monitoring blood pressure circadian rhythm of blood pressure, 120 caseswere divided into the normal rhythm of blood pressure and the abnormal blood pressure rhythm group. Collected medical history ; Tested related test index respectively ; Cardiac ultrasound. According to the formula to calculate residual renal function, left ventricular mass index, Eingabe/Ausgabe, Ejection Fraction. Univariate and multivariate unconditional logistic regression analysis was used to analyze the risk factors of circadian rhythm of blood pressure. Stepwise multiple linear regression analysis was used to analyze the risk factors of residual renal function and cardiac function. Results CAPD patients with normal blood pressure rhythm in 14 cases（11.7%）, abnormal blood pressure rhythm in 106 cases（ 88.3% ）, Among them, non dipper blood pressure accounted for 75 cases（62.5%）. Single factor and multiple factors unconditioned logistic regression analysis revealed that after the comparison of gender and age, Risk factors for abnormal circadian rhythm of blood pressure were ： UA（OR=l.197, 95%CI： 1.099-1.441）, CRP（OR=I.170, 95%CI： 1.061-1.331）, RRF（OR=l.389, 95%CI： 1.160-1.779）. Using stepwise multiple linear regression analysis of dangerous factors affecting residual renal function and cardiac function, we found ： Residual renal function negatively correlated with left ventricular myocardial mass index, systolic blood pressure drops at night rate, and ultrafiltration volume ; LVMI （cardiac function） Positively correlated with 24 h average systolic blood pressure, and negatively correlated with systolic blood pressure drop ratio and residual renal function at night. Abnormal circadian rhythm of blood pressure may lead to the decline of residual renal function and cardiac function. Conclusions UA, CRP and RRF may affect the CAPD patients blood pressure circadian rhythm. At the same time, abnormal circadian rhythm of blood pressure may lead to the decline of residual renal function and cardiac function. Therefore, pay attention to the monitoring and control of ABPM, can better protect the residual renal function and improve cardiac function, so as to prolong and improve the survival time and quality of life of patients with CAPD.