IgA肾病患者清晨高血压与肾功能关系的研究

Relationship between morning hypertension and renal function in patients with IgA nephropathy

目的:分析IgA肾病患者不同肾功能水平的动态血压及清晨血压情况。方法:纳入经肾组织活检确诊的189例IgA肾病非透析患者,根据估算肾小球滤过率(estimated glomerular filtration rate,eGFR)进行慢性肾脏病(chronic kidney disease,CKD)分期,利用携带式动态血压检测仪收集患者动态血压,包括24 h收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)、日间SBP(daytime SBP,dSBP)和日间DBP(daytime DBP,dDBP)、夜间SBP(nighttime SBP,nSBP)和夜间DBP(nighttime DBP,nDBP),分析不同CKD分期的IgA肾病患者清晨高血压的发生率。结果:IgA肾病患者24 h动态血压监测结果显示,与CKD1、2期患者相比,CKD4、5期患者24 hSBP、dSBP、nSBP均升高(均P<0.05),而24 hDBP、dDBP、nDBP无明显差异(均P>0.05)。CKD1~5期IgA肾病患者清晨高血压的发生率分别为23.5%、25.7%、30.0%、52.8%和63.6%。与CKD1~3期的IgA肾病患者相比,CKD4、5期患者的清晨高血压发生率均升高(均P<0.05)。CKD4、5期患者的清晨平均SBP分别为(142.4±24.6)mmHg(1 mmHg=0.133 kPa)和(146.3±22.6)mmHg,显著高于CKD1、2期[(123.8±18.2)mmHg和(129.4±22.4)mmHg](均P<0.05),而清晨平均DBP均无明显差异(均P>0.05)。结论:CKD4~5期的IgA肾病患者清晨高血压的发生率明显升高,应重视患者24 h血压监测,加强清晨高血压的控制,尤其是对中晚期CKD患者。

Objectives To explore the variation and morning blood pressure in patients with IgA nephropathy by ambulatory blood pressure monitoring.Methods The status of chronic kidney disease(CKD)of the 189 patients with IgA nephropathy diagnosed by biopsy were staged according to the estimated glomerular filtration rate(eGFR).The blood pressure was examined by a portable ambulatory blood pressure monitoring(ABPM),and the paraments including 24-hour systolic blood pressure(24hSBP),24-hour diastolic blood pressure(24hDBP),daytime SBP(dSBP),daytime DBP(dDBP),nighttime SBP(nSBP)and nighttime DBP(nDBP)were acquired.Results The 24hSBP,dSBP and nSBP were higher in patients with CKD stage 4 and 5 than those in patients with CKD stage 1 and 2(all P<0.05),while 24hDBP,dDBP and nDBP did not change significantly(all P>0.05).The morning hypertension was more commonly found in patients with advanced stage of CKD,with an incidence rate of 23.5%,25.7%,30.0%,52.8%and 63.6%for patients with CKD1-5 IgA nephropathy respectively,and the difference between patients with CKD1-3 and CKD4-5 was statistically significant(P<0.05).Moreover,the average SBP of CKD4,5 patients in the morning,(142.4±24.6)mmHg(1 mmHg=0.133 kPa)and(146.3±22.6)mmHg respectively,were significantly higher than those of CKD1,2 patients,(123.8±18.2)mmHg and(129.4±22.4)mmHg(all P<0.05).There was no significant difference of average DBP in the morning among patients with different stage of CKD(P>0.05).Conclusions The incidence of early morning hypertension in patients with IgA nephropathy of CKD stage 4,5 was significantly increased,demanding more attention to the stable control of 24-hour blood pressure,especially in patients with CKD of middle and late stages.