血压正常的糖尿病患者动态脉压与早期肾功能的相关性研究

The relationship between dynamic pulse pressure and early renal function in diabetes mellitus patients with normal blood pressure

目的探讨血压正常的糖尿病(DM)患者动态脉压与尿微量白蛋白/尿肌酐比值(UACR)的相关性。方法选择2013年10月~2015年3月于宜昌市夷陵医院门诊患者中纳入符合标准的糖尿病(DM)患者121例,根据24 h动态脉压水平分为A组(脉压<50 mm Hg,n=42)(1 mm Hg=0.133k Pa)、B组(50 mm Hg≤脉压≤70 mm Hg,n=48)、C组(脉压>70 mm Hg,n=31)。结果以UACR作为早期肾功能损害的指标,观察各组动态脉压与UACR水平,探讨动态脉压与DM患者早期肾脏损害的相关性。三组患者在传统肾功能指标,如血肌酐(Scr)、血尿素氮(BUN)、血尿酸(UA)方面比较无显著差异(P>0.05),而在早期肾功能指标UACR方面比较,差异均有统计学意义(P<0.05);Pearson相关分析显示,UACR与年龄、诊室舒张压(DBP)、24 h平均脉压(24 hm PP)、白天平均脉压(dm PP)、夜间平均脉压(nm PP)呈正相关(P<0.05),但与诊室收缩压(SBP)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血清空腹血糖(FBG)、糖化血红蛋白(Hb A1c)无相关性(P>0.05);多元线性逐步回归分析,24 h平均脉压(24 hm PP)、夜间平均脉压(nm PP)为UACR的影响因素(P<0.05)。结论血压正常的DM患者,随着脉压差的增大,早期肾功能指标UACR也明显升高,提示动态脉压与早期糖尿病肾病(DN)有关。

Objective To investigate the relationship between dynamic pulse pressure and urinary albumin creatinine ratio (UACR) in diabetes mellitus (DM) patients with normal blood pressure. Methods A total of 121 patients with DM qualified were enrolled. The 121 patients were divided into A group (PP<50 mmHg, n=42), B (50 mmHg≤PP≤70 mmHg, n=48) and C group (PP>70 mmHg, n=31) according to 24-hour dynamic pulse pressure (PP) levels. Results UACR was used as an indicator of early renal impairment to discuss the relationship between dynamic PP and UACR by investigating UACR and dynamic PP levels in each group. Among three groups, there were no statistically significant differences (P>0.05) in the traditional indicators of kidney function, such as serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA). There were statistically significant differences in the early indicators of kidney function, such as UACR (P<0.05). Result of Pearson correlation analysis showed that UACR were positively correlated with age, consulting room diastolic blood pressure (DBP), 24-hour mean PP, day mean PP, night mean PP (P<0.05), but there was no close correlation (P>0.05) with consulting room systolic blood pressure (SBP), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), haemoglobinA1C (HbA1c). Result of multivariate regression analysis indicated that 24 h pulse pressure (24h mPP), mean pulse pressure at night (mPP) were impact factors of UACR (P<0.05). Conclusion In DM patients with normal blood pressure, UACR (i.e. early renal function index) was significantly increased along with the increase of pulse pressure, suggesting that dynamic pulse pressure is correlated with early diabetic nephropathy (DN).