非杓型高血压对肾动脉血流动力学影响的相关性研究

Effect of blood pressure rhythms on kidney hemodynamics in essential hypertensive patients

目的:探讨原发性高血压患者中血压节律(杓型和非杓型)对肾脏血流动力学(叶间动脉收缩期峰值流速和阻力指数的影响)。方法:采用前瞻性横断面研究设计,收集2019年1月至2019年10月在广东医科大学第三附属医院心血管内科就诊的符合入组条件的原发性高血压患者386例,按24 h动态血压结果分为杓型组和非杓型组,分别比较两组叶间动脉收缩期峰值流速(PSV)、舒张期末速度(EDV)、搏动指数(PI)、阻力指数(RI)的差异。采用多元线性回归模型探讨血压节律与肾脏血流动力学的关系。结果:386例中共155例出现非杓型血压,发生率为(42.1%)。与杓型组相比,非杓型组PSV(22.1±6.8)vs.(28.7±5.9)cm/s、EDV(17.24±8.3)vs.(22.2±7.6)cm/s低PI(1.14±0.08)vs.(1.02±0.06)、RI高(0.76±0.05)vs.(0.68±0.03),差异有统计学意义(P<0.05)。多元线性回归模型显示与杓型组相比,非杓型组降低约5.94 cm/s PSV速度(95%CI:-3.32^-7.98)及5.38 cm/s EDV速度(95%CI:-3.17^-8.02),增加PI约0.11(95%CI:0.03~0.28)及RI指数约0.07(95%CI:0.08~0.24)。结论:血压节律的改变能够影响肾脏血流动力学变化,为后续血压干预从而减少肾功能损害提供理论依据。

Objective: To investigate the effect of blood pressure rhythms on kidney hemodynamics in essential hypertensive patients. Methods: A prospective cross-sectional study design was used to collect 386 patients with essential hypertension who met the enrollment conditions from January 2019 to October 2019 in the 3 rd affiliated hospital of Guangdong Medical University. They were divided into the dipper-type group and the non-dipper type group according to the 24 h ambulatory blood pressure reports. The differences in peak systolic velocity(PSV), end-diastolic velocity(EDV), pulsatility index(PI), and resistance index(RI) of the interlobar arteries were compared between the two groups. Multiple linear regression model was used to explore the relationship between blood pressure rhythm and renal hemodynamics. Results: A total of 155 people had non-dipper type blood pressure(42.1%). Compared with the dipper-type group, the non-dipper type group has lower PSV(22.1±6.8) vs.(28.7±5.9) cm/s, EDV(17.2±8.3) vs.(22.2±7.6) cm/s, and PI(1.14±0.08) vs.(1.02±0.06). But the RI was high(0.76±0.05) vs.(0.68±0.03), and the difference was statistically significant(P<0.05). The multiple linear regression model showed that compared with the dipper-type group, the non-dipper-type group reduced the PSV speed by 5.94 cm/s(95% CI:-3.32--7.98) and EDV speed by 5.38 cm/s(95% CI:-3.17--8.02), increase the PI by about 0.11(95% CI: 0.03-0.28) and the RI index by about 0.07(95% CI: 0.08-0.24). Conclusions: Changes in blood pressure rhythm can affect renal hemodynamic changes, and provide a theoretical basis for subsequent blood pressure intervention to reduce renal function damage.