原发性高血压患者动态脉压和昼夜节律异常对早期肾损害的预测价值

Value of 24-hour Pulse Pressure and Abnormal Circadian Rhythm Blood Pressure in Predicting Early Renal Impairment in Essential Hypertension Patients

目的:探讨原发性高血压患者24小时动态脉压(24hPP)、血压昼夜节律对早期肾损害的预测价值。方法:将146例原发性高血压病患者按24hPP分为四组,A组:PP≤40mmHg(28例),B组:41～60mmHg(43例),C组:61～80mmHg(51例)和D组:大于80mmHg(24例);按血压昼夜变化率(ΔMBP)分为两组,杓型组:ΔMBP≥10%(65例),非杓型组:ΔMBP【10%(81例),分别进行24小时动态血压监测和检测血、尿β2微球蛋白(β2-MG)和尿α1微球蛋白(α1-MG)、尿微量白蛋白(mALB)并比较各组的检测值。结果:各组间性别、年龄、体重指数、空腹血糖、血肌酐、总胆固醇、甘油三酯水平均无显著性差异(P〉0.05)。随着24hPP增高,早期肾损害程度越严重,D组】C组】B组】A组(P【0.05);非杓型组夜间收缩压、舒张压及早期肾损害程度明显高于杓型组(P【0.05)。结论:24hPP增大及血压昼夜节律异常可作为高血压患者早期肾损害的预测指标。

To investigate the predict value of 24-hour pulse pressure(24hPP)and abnormal circadian rhythm blood pressure in early renal impairment in patients with essential hypertension(EH).Methods:The 146 EH patients were divided into four groups by the 24 hour mean pulse pressure(24hPP):group A(≤40mmHg,n=28), group B(41～60mmHg,n=43),group C(61～80 mmHg,n=51),group D(>80mmHg,n=24),They were divided into 2 groups by the rate of change of mean blood pressure day and night(ΔMBP):dippers group(ΔMBP≥10%, n=65)and non-dippers group(ΔMBP<10%,n=81).The data of 24-hour ambulatory blood pressure monitoring (24hABPM)was collected and studied,and the blood and urineβ2-microglobulin(β2-MG),the urineα1 microglobulin(α1-MG),albumin were detected,and correlation these indicators was detected.Results General clinical data was not significant difference in each group(P>0.05).The early renal damage was increasing with the increase in the 24hPP,D>C>B>A;The frequency of early damage of kidney and nSBP and nDBP in non-dippers was higher than that in dippers.Conclusion The 24hPP increased and abnormal circadian rhythm blood pressure can be considered as predict indexes of early renal impairment in patients with EH.