维生素D与慢性肾脏病患者夜间血压的相关性分析

Correlation analysis of vitamin D and nocturnal blood pressure in the patients with chronic kidney disease

目的:观察慢性肾脏病患者维生素D水平是否与夜间血压变化相关。方法:纳入2019年6月至2020年2月在我院住院的慢性肾脏病患者120例,其中男性62例,女性58例。平均年龄(55.22±14.33)岁。根据维生素D的水平不同将患者分为3组:≤20 mg/L为维生素D缺乏组;21~29 mg/L为维生素D不足组;≥30 mg/L为维生素D充足组。比较3组患者的人口学特征和临床资料及血压相关指标,同时对维生素D浓度与各变量间的相关性进行分析。结果:维生素D缺乏组(n=40)和不足组(n=45)24 h收缩压、24 h舒张压、夜间收缩压、夜间舒张压均高于维生素D充足组(n=35),而夜间血压下降率低于维生素D充足组(均P<0.05)。维生素D水平与钙(r=-0.259,P=0.026)、24 h收缩压(r=-0.657,P=0.036)、夜间舒张压(r=-0.203,P=0.000)、夜间收缩压(r=-0.198,P=0.000)呈负相关,与夜间收缩压下降率呈正相关(r=0.291,P=0.000)。多元Logistic回归分析结果显示,维生素D缺乏或不足是慢性肾脏病患者夜间高血压的危险因素(P=0.037)。随着血清维生素D水平的降低,夜间高血压下降率减少。结论:慢性肾脏病患者维生素D水平与24 h收缩压、24 h舒张压、夜间收缩压、夜间舒张压呈负相关,与夜间血压下降率呈正相关。

Objective To observe whether vitamin D level is related to changes of blood pressure in the patients with chronic kidney disease.Methods A total of 120 patients(62 male and 58 female)with chronic kidney disease[age,18-80(55.22±14.33)years]were enrolled.The patients were divided into 3 groups based on their vitamin D concentration,including very low vitamin D group(≤20 mg/L),low vitamin D group(21-29 mg/L)and vitamin D sufficient group(≥30 mg/L).The clinical data and blood pressure of 3 groups were compared,and the correlation between vitamin D concentration and each variable was analyzed.Results The levels of 24-h systolic blood pressure,24-h diastolic blood pressure,daytime systolic blood pressure,daytime systolic blood pressure,nocturnal systolic blood pressure,and nocturnal diastolic blood pressure in very low vitamin D group(n=40)and low group(n=45)were higher than those in vitamin D sufficient group(n=35)(all P<0.05),but the dropping rate of blood pressure at night in two groups were lower than the vitamin D sufficient group.It showed that vitamin D level had negative linear correlation with calcium concentration(r=-0.259,P=0.026),24-h systolic blood pressure(r=-0.657,P=0.036),24-h diastolic blood pressure,nocturnal diastolic blood pressure(r=-0.203,P=0.000),nocturnal systolic blood pressure(r=-0.198,P=0.000).However,vitamin D level was positively correlated with the dropping rate of blood pressure at night.Multivariate Logistic regression analysis showed that vitamin D was a risk factor for the development of nocturnal hypertension in the patients with chronic kidney disease(P=0.037).As serum vitamin D levels decreased,the dropping rate of nocturnal hypertension decreased.Conclusions In the patients with chronic kidney disease,vitamin D level was negatively correlated with 24-h systolic blood pressure,24-h diastolic blood pressure,nocturnal systolic blood pressure,and nocturnal diastolic blood pressure,but it was positively correlated with the dropping rate of blood pressure at night.