动脉粥样硬化性肾动脉狭窄患者24小时动态血压特征及靶器官损害相关研究

Correlation between 24 h ambulatory blood pressure characteristics and target organ damage in atherosclerotic renal artery stenosis patients

目的探讨动脉粥样硬化性肾动脉狭窄(ARAS)患者24 h动态血压、昼夜节律变化特征及靶器官损害。方法选择2014年1月~2018年12月在上海交通大学医学院附属瑞金医院高血压科连续住院的ARAS患者121例(ARAS组),另选择同期年龄、性别、体质量指数和高血压病程等匹配的原发性高血压(EH)患者418例(EH组),观察并比较2组诊室及24 h动态血压及靶器官损害的差异。结果与EH组比较,ARAS组诊室收缩压[(155±23)mm Hg(1mm Hg=0.133k Pa)vs(145±22)mm Hg,P<0.01]、诊室脉压[(75±20)mm Hg vs(65±18)mm Hg,P<0.01]、24h收缩压[(143±19)mm Hg vs(130±16)mm Hg,P<0.01]、昼间收缩压[(145±18)mm Hg vs(133±16)mm Hg,P<0.01]、夜间收缩压[(138±21)mm Hg vs(123±18)mm Hg,P<0.01]、夜间舒张压[(75±12)mm Hg vs(73±10)mm Hg,P<0.05]明显升高,差异有统计学意义。与EH组比较,ARAS组杓型血压比例明显降低,反杓型血压比例明显升高(P<0.05)。校正相关因素后,与EH组比较,ARAS组颈动脉内膜中层厚度、左心室质量指数及血浆N末端B型钠尿肽前体水平明显升高,差异有统计学意义(P<0.01)。结论ARAS患者收缩压及夜间血压较高,更多表现为反杓型血压。有独立于血压及肾功能水平更严重的靶器官损害。

Objective To study the characteristics of 24 h ambulatory blood pressure(ABP),circadian rhythm and target organ damage in atherosclerolic renal artery stenosis(ARAS)patients.Methods One hundred and twenty-one ARAS patients served as an ARAS group and 418 essen tial hypertention(EH)patients with their age,gender,BMI and hypertension duration matched served as an EH group.Their consulting room BP,24 h ABP and target organ damage were compared.Results The consulting room SBP and PP,24 h SBP,daytime SBP,nighttime SBP and DBP were significantly higher in ARAS group than in EH group(155±23 mm Hg vs 145±22 mm Hg,P<0.01;143±19 mm Hg 130±16 mm Hg,P<0.01;145±18 mm Hg 133±16 mm Hg,P<0.01;138±21 mm Hg 123±18 mm Hg,P<0.01;75±12 mm Hg 73±10 mm Hg,P<0.05).The incidence of dipper BP was significantly lower while that of reverse dipper BP was significantly higher in ARAS group than in EH group(P<0.05).The carotid artery tunica inlima thickness,left ventricular mass index and serum NT-proBNP level were significantly higher in ARAS group than in EH group after adjustment for related factors(P<0.01).Conclusion The SBP and nighttime BP are considerably high in ARAS patients often manifested as reverse dipper BP.Severer target organ damage is independent of BP and renal function.