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目的探讨动态血压均值、动态脉压及昼夜节律变化与微量蛋白尿的关系,为动态血压监测(ABPM)应用于早期诊断和评价高血压性肾损害提供科学依据。方法选择2003年6月至2004年10月昆明市第一人民医院心内科住院的原发性高血压患者125例,测量动态血压各参数:24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)、24h平均脉压(24hPP)等及尿微量白蛋白(mAlb)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)。(1)根据动态血压测量的结果将受试者按24hPP≤40mm Hg(1mm Hg=0.133kPa)、41~55mm Hg、56~70mm Hg、>70mm Hg分为A、B、C、D组,比较各组的尿mAlb、NAG检测值及其阳性率,行24hSBP、24hDBP、24hPP与尿mAlb、NAG的相关回归分析。(2)根据血压昼夜节律变化,将上述受试者分为“杓型”组和“非杓型”组,比较两组尿mAlb、NAG检测值及其阳性率。结果(1)A组与B组之间,尿mAlb、NAG及微量蛋白尿阳性率差异无显著性意义(P>0.05),B组、C组与D组随24hPP的增高,尿mAlb、NAG及微量蛋白尿阳性率依次明显增高,各组间差异有显著性意义(P<0.05)。(2)24hPP与尿mAlb、NAG呈正相关(r=0.79、0.78,P<0.05),24hSBP与尿mAlb、NAG呈正相关(r=0.78、0.76,P<0.05),24hDBP与mAlb、NAG呈负相关(r=-0.64、-0.65,P<0.05);建立多元回归方程得出高血压早期肾损害时对应的24hSBP、24hDBP及24hPP值分别为150mm Hg、91mm Hg、58mm Hg。(3)“非杓型”组尿mAlb、NAG及微量蛋白尿阳性率明显高于“杓型”组,两组间差异有显著性意义(P<0.05)。结论动态血压均值、动态脉压及昼夜节律变化可为原发性高血压患者早期肾损害的检测评价指标,24hSBP高于150mm Hg、24hPP高于58mm Hg,24hDBP过度下降的患者易出现高血压性肾损害,夜间血压下降率<10%的患者为原发性高血压性肾损害的高危患者。
Objective To investigate the relationship between ambulatory blood pressure (MAP), ambulatory pulse pressure (CPP), circadian rhythm and microalbuminuria, and to provide a scientific basis for the application of ABPM in early diagnosis and evaluation of hypertensive renal impairment. Methods From June 2003 to October 2004, 125 patients with essential hypertension were enrolled in Department of Cardiology, First People’s Hospital of Kunming. The parameters of ambulatory blood pressure were measured: 24h mean systolic pressure (24hSBP), 24h mean diastolic pressure (24hDBP ) 24h mean pulse pressure (24hPP) and urinary microalbumin (mAlb), urine N-acetyl-β-D-glucosaminidase (NAG). (1) According to the results of ambulatory blood pressure measurement, subjects were divided into A, B, C and D groups according to 24hPP≤40mm Hg (1mm Hg = 0.133kPa), 41 to 55mm Hg, 56 to 70mm Hg and> 70mm Hg, The urinary mAlb and NAG detection values and positive rate of each group were compared, and the correlation analysis of 24hSBP, 24hDBP, 24hPP and urine mAlb, NAG were performed. (2) According to the circadian rhythm of blood pressure, the subjects were divided into “dipper” group and “non dipper” group. The urinary mAlb and NAG detection values and their positive rates were compared between the two groups. Results (1) There was no significant difference in the positive rates of urine mAlb, NAG and microalbuminuria between group A and group B (P> 0.05), while those of group B, C and D increased with 24hPP, urine mAlb, NAG And microalbuminuria were significantly increased in turn, the difference between the groups was significant (P <0.05). (2) There was a positive correlation between 24hPP and mAlb and NAG (r = 0.79,0.78, P <0.05), 24hSBP and mAlb and NAG (r = 0.78,0.76, P <0.05) (R = -0.64, -0.65, P <0.05). The multiple regression equation was established and the corresponding 24hSBP, 24hDBP and 24hPP values for early renal hypertension were 150mm Hg, 91mm Hg and 58mm Hg, respectively. (3) The positive rate of urine mAlb, NAG and microalbuminuria in “non-dipper” group was significantly higher than that in “dipper” group. There was significant difference between the two groups (P <0.05). Conclusions The changes of ambulatory blood pressure, ambulatory pulse pressure and circadian rhythm may be the indicators of early renal damage in patients with essential hypertension. 24hSBP is higher than 150mm Hg, 24hPP is higher than 58mm Hg, and patients with over-reduced 24hDBP are prone to be hypertensive Patients with renal impairment and nocturnal blood pressure reduction <10% are at high risk of primary hypertensive renal impairment.