不同血压变量及其变异性对2型糖尿病肾病的影响

Effects of different blood pressure variables and their variabilities on the development of diabetic nephropathy in patients with type 2 diabetes mellitus

目的评估不同血压变量及其变异性对2型糖尿病患者糖尿病肾病(DN)的影响。方法本研究为队列研究,纳入3050例中国台湾李氏联合诊所定期随访的2型糖尿病患者,按要求定期监测其代谢指标,每年进行尿液检查评估其尿白蛋白肌酐比(UACR),随访3~10年(平均7年)。根据患者的血压参数即收缩压、舒张压、脉压及平均动脉压(MAP)测量值计算其平均值和标准差(SD)。根据收缩压均值高于或低于130 mmHg(1 mmHg=0.133 kPa)和收缩压SD高于或低于总体均值11.06 mmHg,患者被分为4组:Q1(收缩压均值<130 mmHg,收缩压SD<11.06 mmHg);Q2(收缩压均值<130 mmHg,收缩压SD≥11.06 mmHg);Q3(收缩压均值≥130 mmHg,收缩压SD<11.06 mmHg);Q4(收缩压均值≥130mmHg,收缩压SD≥11.06)。同理根据脉压均值高于或低于总体均值的80 mmHg和脉压SD高于或低于总体均值6.48 mmHg,患者被重新分为Q1~Q4组。结果校正年龄、性别、病程后,Cox回归分析显示收缩压均值、收缩压SD、脉压均值、脉压SD是影响DN的危险因素。通过收缩压均值和收缩压SD对患者进行分层后发现,Q4组患者发生DN风险最高(HR=1.976,P<0.001),而Q1组患者最低。此外,Q3组患者(HR=1.614,P<0.001)发生DN的风险高于Q2组患者(HR=1.408,P<0.001)。通过脉压均值和脉压SD对患者重新进行分层后发现,Q4组患者发生DN风险最高(HR=1.370,P<0.001),而Q1组患者最低,Q3组患者(HR=1.266,P<0.001)发生DN的风险高于Q2组患者(HR=1.212,P<0.001)。结论收缩压和脉压变异性是影响2型糖尿病患者DN的危险因素。

Objective To analyze the effects of different blood pressure variables and their variabilities on diabetic nephropathy(DN)in patients with type 2 diabetes.Methods This prospective cohort study included 3050 type 2 diabetic patients without DN at baseline from Lee′s clinic in Taiwan,China.The metabolic parameters of patients were regularly checked,and urine albumin creatinine ratio(UACR)were evaluated annually.The average follow-up period was 7 years(3-10 years).The means and standard deviations(SD)of systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse pressure(PP),and mean arterial pressure(MAP)were calculated.According to whether SBP-Mean was higher or lower than 130 mmHg(1 mmHg=0.133 kPa)and SBP-SD was higher or lower than 11.06 mmHg(average SBP-SD),these patients were divided into four groups:Q1(SBP-Mean<130 mmHg,SBP-SD<11.06 mmHg);Q2(SBP-Mean<130 mmHg,SBP-SD≥11.06 mmHg);Q3(SBP-Mean≥130 mmHg,SBP-SD<11.06 mmHg);Q4(SBP-Mean≥130 mmHg,SBP-SD≥11.06 mmHg).In the same way,according to whether PP-Mean was higher or lower than 80 mmHg(average PP-Mean)and PP-SD was higher or lower than 6.48 mmHg(average PP-SD),the patients were divided into Q1-Q4 groups.Results After adjusting age,sex,and diabetes duration,Cox regression analysis showed that SBP-Mean,SBP-SD,PP-Mean,and PP-SD were the risk factors of DN.After the stratification according to SBP-Mean and SBP-SD,the patients in Q4 group(HR=1.976,P<0.001)had the highest risk while those in Q1 group displayed the lowest risk for DN.Additionally,the patients in Q3 group(HR=1.614,P<0.001)imposed a higher risk than that in Q2 group(HR=1.408,P<0.001).By stratificating the patients based on PP-Mean and PP-SD,the patients in Q4 group revealed the highest risk of DN(HR=1.370,P<0.001)while those in Q1 group had the lowest risk.In addition,the patients in Q3 group(HR=1.266,P<0.001)had a higher risk of DN compared with those in Q2 group(HR=1.212,P<0.001).Conclusion SBP and PP variabilities are the predictors of DN in patients with type 2 diabetes.