超声联合ABPM评估老年高血压患者早期肾损害的价值

Value of ultrasound combined with ABPM in evaluating early renal damages in elderly hypertensive patients

目的:探讨超声联合24 h动态血压监测(ABPM)评估老年高血压患者早期肾损害的临床价值。方法:选取102例老年原发性高血压患者,其中高血压合并早期肾损害55例为A组,高血压无早期肾损害47例为B组,健康体检老年人50例为C组。比较3组患者24 h动态血压、肾脏超声血流参数,并进行多元逐步回归分析和ROC曲线分析。结果:A组24 h平均收缩压(SBP)、24 h平均舒张压(DBP)、昼间平均SBP、昼间平均DBP、夜间平均SBP、夜间平均DBP、SBP负荷值、DBP负荷值均大于B组和C组(P<0.05)。A组SBP平滑指数、DBP平滑指数小于B组和C组(P<0.05)。A组SBP变异系数大于B组和C组(P<0.05)。A组中杓型血压百分率低于B组和C组(P<0.05),非杓型血压、反杓型血压百分率高于B组和C组(P<0.05)。A组肾段动脉、叶间动脉的超声血流阻力指数大于B组和C组(P<0.05)。回归分析中SBP平滑指数、SBP变异系数、非杓型血压、反杓型血压、肾段动脉阻力指数是高血压早期肾损害的独立影响因素。超声联合ABPM预测高血压早期肾损害的灵敏度为85.45%,特异度为90.72%,准确率为88.82%,与临床实际诊断的一致性较高(Kappa=0.759)。结论:超声联合ABPM预测高血压早期肾损害有重要价值,可根据肾脏超声血流阻力指数以及ABPM平滑指数与变异系数评估,非杓型血压、反杓型血压会增加早期肾损害的风险。

Objective To explore the clinical value of ultrasound combined with 24 h ambulatory blood pressure monitoring(ABPM)in the evaluation of early renal damages in elderly hypertensive patients.Methods A total of 102 elderly patients with essential hypertension were enrolled in the study,including 55 cases with early renal damages in group A,and 47 cases without early renal damages in group B.Meanwhile,50 healthy elderly subjects were selected and included in group C.The 24 h ambulatory blood pressure and renal ultrasound blood flow parameters of the 3 groups were compared.Moreover,multiple stepwise regression analysis and ROC curve analysis were performed.Results The 24 h mean systolic blood pressure(SBP),24 h mean diastolic blood pressure(DBP),diurnal mean SBP,diurnal mean DBP,nocturnal mean SBP,nocturnal mean DBP,SBP loading value and DBP loading value of group A were all higher than those of group B and group C(P<0.05).The SBP smoothing index and DBP smoothing index of group A were lower than those of group B and group C(P<0.05),but the SBP variability coefficient was higher than that of group B and group C(P<0.05).Compared with those in group B and group C,the percentage of dipper type hypertension was lower in group A(P<0.05),while the percentages of nondipper type hypertension and reverse dipper type hypertension were higher(P<0.05).The ultrasound blood flow resistance indexes(RI)of renal segmental arteries and interlobular arteries in group A were higher than those of group B and group C(P<0.05).Regression analysis found that SBP smoothing index,SBP variability coefficient,non dipper type hypertension,reverse dipper type hypertension and RI of renal segmental arteries were independent risk factors of early renal damages in elderly hypertensive patients.The sensitivity,specificity and accuracy of ultrasound combined with ABPM in the prediction of early renal damages of hypertension were 85.45%,90.72%and 88.82%,respectively,which revealed that the diagnosis by the proposed method was highly consistent with the actual clinical diagnosis(Kappa=0.759).Conclusion Ultrasound combined with ABPM is of great value in predicting early renal damages of hypertension which can be evaluated based on renal ultrasound blood flow RI,ABPM smoothing index and variability coefficient.Nondipper type hypertension and reverse dipper type hypertension will increase the risk of early renal damages.