慢性肾脏病高血压患者夜间高血压患病率及影响因素

Prevalence and influencing factors of night time hypertension in patients with chronic kidney disease and hypertension

目的探讨通过动态血压监测(ABPM)了解慢性肾脏病(CKD)高血压患者夜间高血压的患病率影响因素。方法纳入2017年1月~2017年10月在南充市中心医院肾内科住院的123例CKD合并高血压的患者,使用动态血压监测仪进行ABPM,了解夜间高血压的患病率,根据结果分为夜间高血压组(110例)、非夜间高血压组(13例)。收集两组患者血糖、白蛋白、肌酐、尿素氮、尿酸、血脂、电解质、C反应蛋白、同型半胱氨酸、甲状旁腺素、血红蛋白等检验指标,用心脏彩超评价心脏结构和功能改变,颈部血管彩超评估血管斑块形成情况。采用单因素及多因素Logistic回归分析夜间高血压的影响因素。结果夜间高血压的患病率为89.43%,其中单纯性夜间高血压的患病率为29.27%;与非夜间高血压组相比,夜间高血压组尿素氮、肌酐、尿酸、同型半胱氨酸、甲状旁腺素、血钾、血磷显著升高,肾小球滤过率(GFR)、白蛋白、血红蛋白水平显著减低(P<0.05)。Logistc回归分析结果显示,夜间高血压者与年龄、GFR、白蛋白、肌酐、同型半胱氨酸显著相关(P<0.05)。结论 CKD高血压患者夜间高血压普遍存在,患病率为89.43%,其中年龄、GFR、白蛋白、肌酐、同型半胱氨酸是夜间高血压的影响因素。

Objective To investigate the prevalence of nocturnal hypertension in patients with chronic kidney disease(CKD) by ambulatory blood pressure monitoring(ABPM), and analyze the influencing factors of nocturnal hypertension in CKD patients. Methods From January 2017 to October 2017, 123 CKD patients with hypertension were enrolled in the nephrology department of Nanchong Central Hospital. ABPM was performed with ambulatory blood pressure monitor to understand the prevalence of hypertension at night. According to the results, they were divided into night hypertension group(110 cases) and non night hypertension group(13 cases). Blood glucose, albumin, creatinine, urea nitrogen, uric acid, blood lipid, electrolyte, C-reactive protein, homocysteine, parathyroid hormone and hemoglobin were collected. Color Doppler echocardiography was used to evaluate the changes of heart structure and function, and color Doppler echocardiography was used to evaluate the formation of vascular plaque. Single factor and multiple factor Logistic regression were used to analyze the influencing factors of night time hypertension. Results The prevalence of nocturnal hypertension was 89.43%, and the prevalence of simple nocturnal hypertension was 29.27%. Compared with non nocturnal hypertension group, urea nitrogen, creatinine, uric acid, homocysteine, parathyroid hormone, potassium and phosphorus in blood were significantly increased, GFR, albumin and hemoglobin were significantly decreased in nocturnal hypertension group(P<0.05). Logistc regression analysis showed that there was a significant correlation between nocturnal hypertension and age, GFR, albumin, creatinine, homocysteine(P<0.05). Conclusion The prevalence of nocturnal hypertension was 89.43%. Age, GFR, albumin, creatinine and homocysteine were the influencing factors of nocturnal hypertension.